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General NPI Number Information
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NPI Number | 1770115578
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS INTEGRATED MEDICAL & SPORTS HEALTH, LLC
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 300 MOORE ST STE B
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City | BRISTOL
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State | VA
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Zip | 24201-4495
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Country | US
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Telephone | 276-591-5448
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Fax | 276-591-5447
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Provider Business Mailing Address
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Address Line | 300 MOORE ST STE B
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City | BRISTOL
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State | VA
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Zip | 24201-4495
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Country | US
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Telephone | 276-591-5448
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Fax | 276-591-5447
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS L MUNCY II
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Credential | DC
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Telephone | 276-591-5448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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