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General NPI Number Information
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NPI Number | 1851116685
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Entity Type | Organization
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Legal Business Name | ENDGAME LLC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 402 RED RIVER AVE N STE 3
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City | COLD SPRING
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State | MN
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Zip | 56320-1523
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Country | US
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Telephone | 320-685-8284
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Fax | 320-281-0093
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Provider Business Mailing Address
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Address Line | 3508 16TH AVE S
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City | SAINT CLOUD
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State | MN
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Zip | 56301-4578
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Country | US
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Telephone | 320-224-7069
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Fax | 320-281-0093
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Authorized Official
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Title or Position | OWNER
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Name | DR. LACIE GERHARDSON
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Credential | DC
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Telephone | 320-224-7069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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