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General NPI Number Information
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NPI Number | 1861854267
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Entity Type | Organization
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Legal Business Name | JOSHUA SPRINGS OPERATIONS LLC
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 2995 DESERT SKY BLVD
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442
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Country | US
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Telephone | 928-763-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 HINES ST SE STE 190
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City | SALEM
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State | OR
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Zip | 97302-1337
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | RONALD ZIEBART
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Credential |
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Telephone | 360-882-4500
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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 | AL9873C
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License Number State | AZ
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