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General NPI Number Information
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NPI Number | 1902912108
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Entity Type | Organization
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Legal Business Name | SAINT JOHN HEALTH SYSTEM
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 602 N 5TH ST
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City | MIDDLETOWN
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State | IN
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Zip | 47356-1008
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Country | US
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Telephone | 765-354-2062
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Fax | 765-354-4679
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Provider Business Mailing Address
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Address Line | 10330 N MERIDIAN ST SUITE 201
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City | INDIANAPOLIS
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State | IN
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Zip | 46290-1024
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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 | VICE PRESIDENT
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Name | D. BRUCE HAGA
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Credential |
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Telephone | 317-583-3087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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