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General NPI Number Information
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NPI Number | 1114475399
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Entity Type | Organization
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Legal Business Name | MEDWAYUSA
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Dates
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Enumeration Date | 09/15/2016
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Last Update Date | 09/15/2016
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Provider Practice Location Address
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Address Line | 928 CROWDER DR
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City | CROWLEY
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State | TX
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Zip | 76036-3657
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Country | US
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Telephone | 817-506-7998
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Fax | 817-506-3294
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Provider Business Mailing Address
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Address Line | PO BOX 449
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City | CROWLEY
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State | TX
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Zip | 76036-0449
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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 | OWNER
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Name | MR. CHAD FEASTER
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Credential |
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Telephone | 979-337-4485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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