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General NPI Number Information
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NPI Number | 1164695482
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Entity Type | Organization
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Legal Business Name | JS STAFFORD ENTERPRISES, INC.
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 02/24/2010
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Provider Practice Location Address
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Address Line | 34952 S ELLIS RD SUITE A
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City | MOLALLA
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State | OR
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Zip | 97038-8478
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Country | US
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Telephone | 503-829-5918
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Fax |
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Provider Business Mailing Address
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Address Line | 34952 S ELLIS RD SUITE A
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City | MOLALLA
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State | OR
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Zip | 97038-8478
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Country | US
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Telephone | 503-829-5918
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. SANDRA JEAN STAFFORD
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Credential | LMT
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Telephone | 503-829-5918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 10643
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License Number State | OR
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Taxonomy #2
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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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