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General NPI Number Information
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NPI Number | 1063463370
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Entity Type | Organization
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Legal Business Name | MEDICAL TEAM CORRECTIONAL MEDICAL SERVICES MANAGEMENT, LLC
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 516 N SYCAMORE ST STE C
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City | PALESTINE
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State | TX
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Zip | 75801-2840
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Country | US
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Telephone | 844-266-5319
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Fax | 888-333-8977
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Provider Business Mailing Address
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Address Line | 6760 OLD JACKSONVILLE HWY SUITE 101
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City | TYLER
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State | TX
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Zip | 75703-0572
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Country | US
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Telephone | 855-485-8273
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Fax | 888-333-8977
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Authorized Official
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Title or Position | CHIEF GROWTH OFFICER
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Name | KATRINA DAWN LANIER
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Credential |
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Telephone | 855-485-8273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 000603
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License Number State | TX
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