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General NPI Number Information
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NPI Number | 1871284430
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Entity Type | Organization
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Legal Business Name | ANCHOR MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 7070 S UNION PARK AVE STE 300
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City | MIDVALE
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State | UT
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Zip | 84047-6061
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Country | US
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Telephone | 208-230-0314
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Fax |
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Provider Business Mailing Address
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Address Line | 16924 BUTTERFLY RIDGE RD
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City | CALDWELL
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State | ID
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Zip | 83607-8859
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Country | US
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Telephone | 208-230-0314
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CINDY M STICE
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Credential |
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Telephone | 208-230-0314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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