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General NPI Number Information
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NPI Number | 1942041140
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Entity Type | Organization
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Legal Business Name | MAINLINE VEIN AND WOUND CARE CENTER LLC
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 333 E CITY AVE FL 2
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1512
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Country | US
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Telephone | 845-362-8400
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Fax | 845-362-8474
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Provider Business Mailing Address
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Address Line | 333 E CITY AVE FL 2
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1512
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Country | US
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Telephone |
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Fax | 845-362-8474
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Authorized Official
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Title or Position | OWNER
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Name | STEVE ODEH
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Credential |
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Telephone | 845-362-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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