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General NPI Number Information
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NPI Number | 1235465899
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HOSPITAL AND MEDICAL CENTERS
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 16001 W 9 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4818
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Country | US
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Telephone | 248-849-3392
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Fax |
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Provider Business Mailing Address
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Address Line | 16001 W 9 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4818
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Country | US
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Telephone | 248-849-3392
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Fax |
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | MS. CHARLENE B GORDON
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Credential | M.A.
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Telephone | 248-849-3392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number |
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License Number State |
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