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General NPI Number Information
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NPI Number | 1083911523
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Entity Type | Organization
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Legal Business Name | MELROSE FAMILY CARE MEDICAL CENTER INC
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Dates
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Enumeration Date | 02/18/2011
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 5235 MELROSE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90038-3144
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Country | US
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Telephone | 323-466-0263
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Fax | 323-466-1034
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Provider Business Mailing Address
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Address Line | 5235 MELROSE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90038-3144
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Country | US
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Telephone | 323-466-0263
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Fax | 323-466-1034
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Authorized Official
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Title or Position | CEO
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Name | ARTIS WOODWARD
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Credential | MD
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Telephone | 323-466-0263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | A40488
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A40488
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License Number State | CA
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