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General NPI Number Information
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NPI Number | 1710902671
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Entity Type | Organization
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Legal Business Name | CORVASC MDS PC
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 8433 HARCOURT ROAD SUITE 100
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2193
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Country | US
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Telephone | 317-583-7600
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Fax | 317-583-7601
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Provider Business Mailing Address
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Address Line | 8433 HARCOURT ROAD SUITE 300
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2190
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Country | US
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Telephone | 317-583-7702
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Fax | 317-583-7601
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. LYNNE TROMBLE
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Credential |
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Telephone | 317-583-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 50000804A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 50000804A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 204F00000X
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Taxonomy Name | Transplant Surgery Physician
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License Number | 50000804A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 50000804A
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License Number State | IN
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