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General NPI Number Information
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NPI Number | 1063661098
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Entity Type | Organization
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Legal Business Name | THE CAROL MILGARD BREAST CENTER
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 4525 SOUTH 19TH STREET
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City | TACOMA
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State | WA
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Zip | 98405-1106
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Country | US
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Telephone | 253-761-4200
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Fax | 253-761-4201
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Provider Business Mailing Address
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Address Line | PO BOX 1535
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City | TACOMA
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State | WA
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Zip | 98401-1535
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Country | US
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Telephone | 253-761-4200
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Fax | 253-761-4201
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER
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Name | KIRSTEN MAXWELL
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Credential |
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Telephone | 253-680-3564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State |
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