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General NPI Number Information
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NPI Number | 1073421392
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Entity Type | Organization
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Legal Business Name | MID-SOUTH HEMOPHILIA AND THROMBOSIS CENTER, INC.
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Dates
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Enumeration Date | 08/28/2026
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Last Update Date | 08/28/2026
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Provider Practice Location Address
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Address Line | 2996 KATE BOND RD STE 105
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City | BARTLETT
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State | TN
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Zip | 38133-4062
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Country | US
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Telephone | 317-871-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 8326 NAAB RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1920
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Country | US
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Telephone | 317-871-0000
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Fax | 317-871-0010
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MR. ERIC D GRAY
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Credential |
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Telephone | 317-871-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number |
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License Number State |
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