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General NPI Number Information
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NPI Number | 1245506377
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Entity Type | Organization
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Legal Business Name | CRAWFORD MOBILE HEALTH CLINIC
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Dates
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Enumeration Date | 03/22/2012
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Last Update Date | 03/22/2012
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Provider Practice Location Address
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Address Line | 15865 HIGHWAY 14 WEST
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City | MACON
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State | MS
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Zip | 39341-0402
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Country | US
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Telephone | 662-435-7800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 95
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City | CRAWFORD
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State | MS
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Zip | 39743-0095
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Country | US
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Telephone | 662-435-7800
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Fax |
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Authorized Official
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Title or Position | MANAING PARTNER
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Name | FELICIA DELORIS EDWARDS
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Credential | NP
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Telephone | 662-435-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | R740067
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | R740067
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License Number State | MS
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