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General NPI Number Information
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NPI Number | 1225470107
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Entity Type | Organization
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Legal Business Name | MOBILE MEDICAL UNIT
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 2314 SASSAFRAS ST 200
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City | ERIE
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State | PA
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Zip | 16502-2722
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Country | US
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Telephone | 814-452-7266
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Fax |
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Provider Business Mailing Address
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Address Line | 1910 SASSAFRAS ST 100
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City | ERIE
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State | PA
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Zip | 16502-2716
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Country | US
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Telephone | 814-452-7266
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS AND ANALYTIC
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Name | LISA D LAWRENCE
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Credential |
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Telephone | 814-452-5241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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