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General NPI Number Information
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NPI Number | 1801822341
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Entity Type | Organization
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Legal Business Name | ST. VRAIN ENDOSCOPY CENTER LLC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 1551 PROFESSIONAL LN SUITE 295
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City | LONGMONT
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State | CO
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Zip | 80501-6972
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Country | US
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Telephone | 303-702-5900
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Fax | 720-890-0502
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Provider Business Mailing Address
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Address Line | 382 S ARTHUR AVE
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City | LOUISVILLE
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State | CO
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Zip | 80027-3094
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Country | US
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Telephone | 720-932-7713
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Fax | 720-890-0502
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. PETER S. KAYE
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Credential | M.D., F.A.C.G.
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Telephone | 720-932-7713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 162
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License Number State | CO
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