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General NPI Number Information
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NPI Number | 1114976925
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Entity Type | Organization
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Legal Business Name | EAST TEXAS MANAGEMENT, LLC
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 708 SOUTHVIEW CIRCLE
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City | CENTER
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State | TX
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Zip | 75935
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Country | US
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Telephone | 936-591-9550
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Fax | 936-591-9543
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Provider Business Mailing Address
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Address Line | 14046 MAIN STREET
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City | CHESTER
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State | TX
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Zip | 75936
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Country | US
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Telephone | 936-969-2103
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Fax | 936-969-2767
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | KRISTA M JERNIGAN
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Credential |
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Telephone | 936-969-2103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 007653
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 012132
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License Number State | TX
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