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General NPI Number Information
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NPI Number | 1043017841
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Entity Type | Individual
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Provider Name | MITCHELL KENT MCCORKLE SRNA
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Gender | Male
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 100 MEDICAL CENTER DR
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City | SPRINGFIELD
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State | OH
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Zip | 45504-2687
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Country | US
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Telephone | 937-523-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 8370 UNION DR
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City | GALLOWAY
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State | OH
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Zip | 43119-8242
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Country | US
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Telephone | 937-631-9060
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN.464058
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License Number State | OH
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