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General NPI Number Information
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NPI Number | 1790284669
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Entity Type | Organization
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Legal Business Name | TRILOGY MEDICAL SUPPLIES, LLC.
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 03/01/2018
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Provider Practice Location Address
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Address Line | 5405 OKEECHOBEE BLVD
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City | WEST PALM BEACH
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State | FL
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Zip | 33417-4543
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Country | US
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Telephone | 954-988-0123
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Fax |
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Provider Business Mailing Address
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Address Line | 5405 OKEECHOBEE BLVD STE 305
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City | WEST PALM BEACH
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State | FL
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Zip | 33417-4554
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Country | US
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Telephone | 561-660-6648
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DAMIAN BODDEN
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Credential |
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Telephone | 561-660-6648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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