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General NPI Number Information
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NPI Number | 1023273885
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL CARE SERVICES PROVIDERS, LLC
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 303 BAILEY RD
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City | LUMBERTON
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State | NC
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Zip | 28358-2427
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Country | US
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Telephone | 910-739-5891
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Fax |
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Provider Business Mailing Address
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Address Line | 303 BAILEY RD
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City | LUMBERTON
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State | NC
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Zip | 28358-2427
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/DIRECTOR
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Name | MR. FERRISS YARNELL LOCKLEAR SR.
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Credential | M.D.
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Telephone | 910-618-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 01444
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License Number State | NC
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