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General NPI Number Information
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NPI Number | 1942744552
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Entity Type | Organization
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Legal Business Name | MEDICAL CREDENTIALING SOLUTIONS LLC
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Dates
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Enumeration Date | 12/15/2016
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 4845 S RAINBOW BLVD SUITE 401
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City | LAS VEGAS
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State | NV
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Zip | 89103-4916
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Country | US
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Telephone | 702-475-8400
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Fax | 702-475-5005
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Provider Business Mailing Address
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Address Line | 9601 TETON VISTA AVE
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City | LAS VEGAS
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State | NV
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Zip | 89117-6736
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Country | US
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Telephone | 702-475-8400
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Fax | 702-475-5005
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Authorized Official
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Title or Position | MBA
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Name | ROBERT JOHNSON
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Credential |
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Telephone | 702-475-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | DO1810
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License Number State | NV
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