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General NPI Number Information
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NPI Number | 1205134715
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Entity Type | Organization
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Legal Business Name | ELITE MEDICAL SERVICES
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Dates
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Enumeration Date | 03/08/2011
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 1236 FM 2824
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City | BEEVILLE
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State | TX
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Zip | 78102-8229
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Country | US
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Telephone | 361-358-1103
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 189
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City | BEEVILLE
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State | TX
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Zip | 78104-0189
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Country | US
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Telephone | 361-358-1103
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | ANDREA KAE CASTILLA
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Credential | R.N, M.S.N.
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Telephone | 361-358-1103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | M2475
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | M2475
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License Number State | TX
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