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General NPI Number Information
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NPI Number | 1093577314
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Entity Type | Organization
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Legal Business Name | HEART AND MIND LLC
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Dates
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Enumeration Date | 01/24/2024
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 2415 S SIGNAL BUTTE RD
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City | MESA
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State | AZ
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Zip | 85209-2107
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Country | US
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Telephone | 480-418-6727
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Fax |
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Provider Business Mailing Address
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Address Line | 2036 N GILBERT RD STE 2
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City | MESA
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State | AZ
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Zip | 85203-2123
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JONATHAN KIRKHAM
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Credential |
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Telephone | 623-205-0456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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