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General NPI Number Information
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NPI Number | 1982802203
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Entity Type | Organization
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Legal Business Name | BEAUMONT WEST BLOOMFIELD ASC LLC
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Dates
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Enumeration Date | 07/08/2007
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 6900 ORCHARD LAKE ROAD SUITE LL100
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322
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Country | US
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Telephone | 248-406-2400
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Fax | 248-406-2401
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Provider Business Mailing Address
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Address Line | 6900 ORCHARD LAKE ROAD SUITE LL100
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322
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Country | US
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Telephone | 248-406-2400
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Fax | 248-406-2401
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHN T FOX
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Credential |
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Telephone | 248-213-3334
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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 | 1010000081
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License Number State | MI
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