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General NPI Number Information
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NPI Number | 1730426982
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Entity Type | Organization
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Legal Business Name | MEDICAL SERVICE PROVIDERS LLC
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Dates
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Enumeration Date | 01/08/2013
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 14229 ROUTE 35
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City | RICHFIELD
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State | PA
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Zip | 17086-8711
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Country | US
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Telephone | 570-743-1809
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Fax |
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Provider Business Mailing Address
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Address Line | 620 STONEBRIDGE DR
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City | SELINSGROVE
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State | PA
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Zip | 17870-7509
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Country | US
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Telephone | 570-743-1809
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GENE WILLIAM REISINGER
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Credential | DO
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Telephone | 570-743-1809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS005081L
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License Number State | PA
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