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General NPI Number Information
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NPI Number | 1629491295
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Entity Type | Organization
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Legal Business Name | OSTEOPATHIC CENTER
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Dates
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Enumeration Date | 02/01/2014
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Last Update Date | 02/01/2014
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Provider Practice Location Address
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Address Line | 4320 BALL CAMP PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37921-3312
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Country | US
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Telephone | 865-693-8772
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Fax | 865-219-2848
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Provider Business Mailing Address
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Address Line | 4801 S UNIVERSITY DR
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City | DAVIE
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State | FL
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Zip | 33328-3839
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Country | US
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Telephone | 954-634-4292
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Fax | 954-634-4293
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Authorized Official
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Title or Position | COO
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Name | JAYNE M MONTROSS
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Credential |
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Telephone | 865-693-8772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO0000002081
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License Number State | TN
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