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NPI 1134465479

NPI 1134465479 : POLLY POSTON HIS : SUMTER, SC

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General NPI Number Information
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    NPI Number           |    1134465479
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    Entity Type          |    Individual 
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    Provider Name        |    POLLY POSTON HIS
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    12/13/2012
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    Last Update Date     |    12/13/2012
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Provider Practice Location Address
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    Address Line         |    706 BULTMAN DR 
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    City                 |    SUMTER
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    State                |    SC
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    Zip                  |    29150-2517
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    Country              |    US
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    Telephone            |    803-773-4199
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    11900 US HIGHWAY 280 
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    City                 |    ELLABELL
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    State                |    GA
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    Zip                  |    31308-3603
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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    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    237700000X
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    Taxonomy Name        |    Hearing Instrument Specialist
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    License Number       |    HTP0824
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    License Number State |    SC
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