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General NPI Number Information
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NPI Number | 1881082337
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Entity Type | Organization
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Legal Business Name | OMNICARE PHYSICIAN PROVIDERS LLC
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 405 STATE HIGHWAY 121 BYP SUITE A250
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City | LEWISVILLE
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State | TX
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Zip | 75067-8214
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Country | US
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Telephone | 469-573-5017
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Fax | 888-431-4912
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Provider Business Mailing Address
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Address Line | 405 STATE HIGHWAY 121 BYP SUITE A250
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City | LEWISVILLE
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State | TX
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Zip | 75067-8214
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Country | US
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Telephone | 469-573-5017
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Fax | 888-431-4912
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Authorized Official
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Title or Position | CEO
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Name | NICK MAJECKI
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Credential |
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Telephone | 469-573-5017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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