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NPI 1174330393

NPI 1174330393 : HONOR WAY : LA VERGNE, TN

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General NPI Number Information
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    NPI Number           |    1174330393
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    Entity Type          |    Organization 
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    Legal Business Name  |    HONOR WAY 
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Dates
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    Enumeration Date     |    12/11/2024
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    Last Update Date     |    12/11/2024
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Provider Practice Location Address
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    Address Line         |    1711 JIMMY CV 
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    City                 |    LA VERGNE
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    State                |    TN
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    Zip                  |    37086-2566
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    Country              |    US
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    Telephone            |    615-479-3058
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    1711 JIMMY CV 
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    City                 |    LA VERGNE
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    State                |    TN
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    Zip                  |    37086-2566
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    Country              |    US
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    Telephone            |    615-479-3058
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    Fax                  |    
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Authorized Official
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    Title or Position    |    OWNER
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    Name                 |     JEREMIAS  BENCITO 
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    Credential           |    
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    Telephone            |    615-479-3058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    347C00000X
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    Taxonomy Name        |    Private Vehicle
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    License Number       |    
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    License Number State |    
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Taxonomy #2
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    Taxonomy Code        |    343900000X
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    Taxonomy Name        |    Non-emergency Medical Transport (VAN)
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    License Number       |    
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    License Number State |    
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