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General NPI Number Information
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NPI Number | 1043574858
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Entity Type | Organization
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Legal Business Name | MOBILE RESPIRATORY AND ANCILLARY LLC
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 3330 FULLERTON ST
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City | DETROIT
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State | MI
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Zip | 48238-3317
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Country | US
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Telephone | 313-926-1525
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Fax |
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Provider Business Mailing Address
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Address Line | 3330 FULLERTON ST
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City | DETROIT
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State | MI
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Zip | 48238-3317
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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 | OWNER
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Name | MR. MICHAEL JOHNSON
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Credential |
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Telephone | 313-926-1526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2278G1100X
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Taxonomy Name | General Care Certified Respiratory Therapist
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License Number |
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License Number State |
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