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General NPI Number Information
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NPI Number | 1942263363
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Entity Type | Organization
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Legal Business Name | MEMORIAL SURGICARE LTD
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 3901 UNIVERSITY BLVD S SUITE 111
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4377
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Country | US
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Telephone | 904-448-1948
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Fax | 904-448-8889
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Provider Business Mailing Address
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Address Line | 3901 UNIVERSITY BLVD S SUITE 111
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4377
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Country | US
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Telephone | 904-448-1948
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Fax | 904-448-8889
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DON LIEDTKE
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Credential |
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Telephone | 615-344-5507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | AHCA989
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License Number State | FL
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