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General NPI Number Information
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NPI Number | 1891182143
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Entity Type | Organization
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Legal Business Name | ADVANCED INTEGRATED CARE ORGANIZATION, LLC
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Dates
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Enumeration Date | 04/23/2015
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 5423 S. FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33813
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Country | US
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Telephone | 863-797-0053
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1089
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City | HIGHLAND CITY
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State | FL
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Zip | 33846-1089
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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 | MEMBER
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Name | SANDRA M CARDONA
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Credential |
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Telephone | 863-797-0053
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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 |
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License Number State |
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