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General NPI Number Information
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NPI Number | 1104538768
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Entity Type | Organization
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Legal Business Name | REIVITALIZE THERAPY INFUSIONS & HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 220 SUNFLOWER AVE
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City | CLARKSDALE
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State | MS
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Zip | 38614-4221
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Country | US
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Telephone | 662-351-2035
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Fax | 662-351-2045
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Provider Business Mailing Address
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Address Line | PO BOX 1744
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City | CLARKSDALE
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State | MS
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Zip | 38614-8544
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Country | US
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Telephone | 662-351-2035
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Fax | 662-351-2045
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. ANNA JONES
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Credential | FNP-C
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Telephone | 662-351-2035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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