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General NPI Number Information
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NPI Number | 1740472943
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Entity Type | Organization
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Legal Business Name | CENTRAL INDIANA PET, LLC
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 8402 HARCOURT RD SUITE 721
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2074
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Country | US
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Telephone | 317-338-6384
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Fax | 317-338-6385
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Provider Business Mailing Address
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Address Line | 8402 HARCOURT RD SUITE 721
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2074
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Country | US
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Telephone | 317-338-6384
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Fax | 317-338-6385
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Authorized Official
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Title or Position | MANAGER
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Name | JOANNA SUE KLAVON
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Credential |
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Telephone | 317-338-6384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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