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General NPI Number Information
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NPI Number | 1922289586
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Entity Type | Organization
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Legal Business Name | WELL CARE CENTERS LLC
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Dates
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Enumeration Date | 11/23/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 4941 CLAIRTON BLVD
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City | PITTSBURGH
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State | PA
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Zip | 15236-2101
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Country | US
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Telephone | 412-673-2710
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Fax | 412-673-9311
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Provider Business Mailing Address
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Address Line | 300 NORTH MONONGAHELA AVENUE
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City | GLASSPORT
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State | PA
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Zip | 15045
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Country | US
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Telephone | 412-673-2710
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Fax | 412-673-9311
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIAM DONOFRIO
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Credential |
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Telephone | 412-673-2710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 029404
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License Number State | PA
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