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General NPI Number Information
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NPI Number | 1699829788
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Entity Type | Organization
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Legal Business Name | NORTHCOAST INFUSION THERAPIES LTD.
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 232 WEST AVE
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City | TALLMADGE
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State | OH
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Zip | 44278-2110
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Country | US
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Telephone | 440-735-7150
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Fax | 440-735-7155
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Provider Business Mailing Address
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Address Line | 7710 FIRST PL BLDG E, SUITE H
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City | OAKWOOD VILLAGE
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State | OH
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Zip | 44146-6717
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Country | US
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Telephone | 440-735-7150
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Fax | 440-735-7155
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MR. KENNETH SPEIDEL
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Credential | RPH PHARMD
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Telephone | 440-735-7150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 02-100200
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License Number State | OH
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