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General NPI Number Information
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NPI Number | 1689842692
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Entity Type | Organization
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Legal Business Name | TRI-STATE MEDICAL, INC.
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 11/05/2008
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Provider Practice Location Address
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Address Line | 271 E. MAIN STREET
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City | MOREHEAD
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State | KY
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Zip | 40351
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Country | US
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Telephone | 606-783-7053
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Fax | 606-783-7058
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Provider Business Mailing Address
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Address Line | 271 E. MAIN STREET
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City | MOREHEAD
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State | KY
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Zip | 40351
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Country | US
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Telephone | 606-783-7053
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Fax | 606-783-7058
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ANGELA GAY ANDERSON
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Credential | COF
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Telephone | 606-783-7053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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