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General NPI Number Information
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NPI Number | 1124247200
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Entity Type | Organization
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Legal Business Name | PROMISE HEALTH SERVICES LLC
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 207 16TH ST SUITE 404
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City | ASHLAND
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State | KY
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Zip | 41101-7909
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Country | US
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Telephone | 866-439-3465
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Fax | 866-731-7460
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Provider Business Mailing Address
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Address Line | 207 16TH ST SUITE 404
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City | ASHLAND
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State | KY
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Zip | 41101-7909
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Country | US
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Telephone | 866-439-3465
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Fax | 866-731-7460
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Authorized Official
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Title or Position | CHIEF EXECUTIVE MANAGER
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Name | DERRICK GENE HAMMOND
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Credential |
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Telephone | 866-439-3465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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