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General NPI Number Information
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NPI Number | 1861657256
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Entity Type | Organization
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Legal Business Name | INDIANA ENDOSCOPY CENTERS LLC
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 10967 ALLISONVILLE RD SUITE 100
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City | FISHERS
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State | IN
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Zip | 46038-2630
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Country | US
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Telephone | 317-962-5660
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 N SENATE BLVD SUITE 410
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-1228
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Country | US
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Telephone | 317-962-5660
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT BOEGLIN
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Credential |
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Telephone | 317-962-5660
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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 | 08-006221-1
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License Number State | IN
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