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General NPI Number Information
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NPI Number | 1851446470
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Entity Type | Organization
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Legal Business Name | COOP MANAGED HEALTH CARE LLC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 5028 ASHLEY LAKE DRIVE UNIT 331
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City | BOYNTON BEACH
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State | FL
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Zip | 33437
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Country | US
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Telephone | 704-719-0161
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Fax |
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Provider Business Mailing Address
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Address Line | 5028 ASHLEY LAKE DR UNIT 331
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3176
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Country | US
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Telephone | 704-719-0161
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS LINDA KAY FULLER
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Credential | RN
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Telephone | 704-719-0161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | RN 9245770
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License Number State | FL
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