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General NPI Number Information
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NPI Number | 1720035249
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Entity Type | Organization
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Legal Business Name | CORAM HEALTHCARE OF WYOMING, LLC
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Dates
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Enumeration Date | 05/29/2006
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Last Update Date | 10/08/2007
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Provider Practice Location Address
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Address Line | 1507 STILLWATER AVE SUITE C
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City | CHEYENNE
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State | WY
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Zip | 82009-7358
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Country | US
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Telephone | 307-635-3785
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Fax | 307-635-7002
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Provider Business Mailing Address
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Address Line | 1675 BROADWAY SUITE 900
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City | DENVER
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State | CO
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Zip | 80202-4675
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Country | US
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Telephone | 303-672-8631
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Fax | 303-298-0047
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Authorized Official
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Title or Position | SR VP
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Name | VITO PONZIO, JR
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Credential |
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Telephone | 303-672-8631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number | N/A
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License Number State | WY
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