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General NPI Number Information
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NPI Number | 1770393399
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Entity Type | Organization
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Legal Business Name | ST MARKS HOSPITALIST PROGRAM, LLC
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 1200 E 3900 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84124-1300
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Country | US
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Telephone | 801-268-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 HEALTH PARK DR
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City | BRENTWOOD
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State | TN
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Zip | 37027-4692
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Country | US
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Telephone | 615-373-7406
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JOSH DEBRY
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Credential |
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Telephone | 801-568-5942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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