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General NPI Number Information
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NPI Number | 1700425816
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Entity Type | Organization
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Legal Business Name | NEW SOURCE MEDICAL, LLC
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Dates
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Enumeration Date | 01/06/2020
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 9913 SHELBYVILLE RD STE 203
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City | LOUISVILLE
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State | KY
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Zip | 40223-2907
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Country | US
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Telephone | 502-261-0050
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Fax |
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Provider Business Mailing Address
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Address Line | 9913 SHELBYVILLE RD STE 203
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City | LOUISVILLE
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State | KY
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Zip | 40223-2907
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Country | US
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Telephone | 502-261-0050
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEVIN A MCKIM
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Credential |
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Telephone | 502-261-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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