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General NPI Number Information
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NPI Number | 1750054631
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Entity Type | Organization
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Legal Business Name | PSMG CLINIC LLC
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Dates
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Enumeration Date | 07/27/2021
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 4910 RAY RD SUITE 1
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City | CHANDLER
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State | AZ
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Zip | 85226
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Country | US
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Telephone | 440-666-2469
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Fax |
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Provider Business Mailing Address
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Address Line | 7904 E CHAPARRAL RD STE A110-475
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City | SCOTTSDALE
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State | AZ
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Zip | 85250-7370
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JIM ROSSIE
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Credential |
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Telephone | 602-881-9560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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