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General NPI Number Information
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NPI Number | 1639159916
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Entity Type | Organization
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Legal Business Name | GI ENDOSCOPY CENTER, INC
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2560 NW MEDICAL PARK DR
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City | ROSEBURG
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State | OR
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Zip | 97470-5510
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Country | US
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Telephone | 541-673-2046
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Fax | 541-673-0454
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Provider Business Mailing Address
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Address Line | 2560 NW MEDICAL PARK DR
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City | ROSEBURG
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State | OR
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Zip | 97470-5510
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Country | US
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Telephone | 541-673-2046
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Fax | 541-673-0454
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Authorized Official
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Title or Position | ASSISTANT ADMINISTRATOR
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Name | DEBORAH D DIXON
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Credential |
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Telephone | 541-957-7734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | 071432
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License Number State | OR
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