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General NPI Number Information
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NPI Number | 1235789041
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Entity Type | Organization
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Legal Business Name | MAPLESHADE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | 960 OHIO DR
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City | PLANO
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State | TX
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Zip | 75093
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Country | US
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Telephone | 281-309-8370
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Fax |
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Provider Business Mailing Address
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Address Line | 960 OHIO DR, SUITE 100
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City | PLANO
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State | TX
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Zip | 75093-5556
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Country | US
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Telephone | 972-599-1447
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GAOLIAN XIE
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Credential |
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Telephone | 281-309-8370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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