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General NPI Number Information
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NPI Number | 1700202264
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Entity Type | Organization
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Legal Business Name | ADVANCED CARE MSO INC
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Dates
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Enumeration Date | 03/07/2014
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Last Update Date | 03/07/2014
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Provider Practice Location Address
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Address Line | 6355 NW 36TH ST SUITE 406
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-7027
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Country | US
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Telephone | 786-543-4327
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Fax | 305-874-3905
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Provider Business Mailing Address
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Address Line | 6355 NW 36TH ST SUITE 406
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-7027
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Country | US
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Telephone | 786-543-4327
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Fax | 305-874-3905
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Authorized Official
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Title or Position | CEO
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Name | PEDRO HERNANDEZ
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Credential |
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Telephone | 786-543-4327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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