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General NPI Number Information
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NPI Number | 1093387458
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Entity Type | Organization
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Legal Business Name | MAIDS
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Dates
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Enumeration Date | 07/14/2021
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 6831 CRUMPLER BLVD STE 100
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-2055
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Country | US
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Telephone | 901-487-1912
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Fax |
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Provider Business Mailing Address
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Address Line | 3109 JOHN MICHAEL DR
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City | SOUTHAVEN
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State | MS
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Zip | 38672-8597
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Country | US
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Telephone | 662-347-2052
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Fax |
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Authorized Official
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Title or Position | BILLER
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Name | CALINA L PATTERSON
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Credential |
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Telephone | 662-347-2052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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