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General NPI Number Information
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NPI Number | 1265616825
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Entity Type | Organization
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Legal Business Name | SIGNATURE PROVIDER SERVICES LLC
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 9815 BROWNSBORO RD SUITE #102
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City | LOUISVILLE
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State | KY
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Zip | 40241-1125
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Country | US
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Telephone | 502-568-7800
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Fax | 502-568-7150
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Provider Business Mailing Address
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Address Line | 9815 BROWNSBORO RD SUITE #102
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City | LOUISVILLE
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State | KY
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Zip | 40241-1125
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Country | US
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Telephone | 502-568-7338
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Fax | 502-568-7954
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Authorized Official
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Title or Position | CFO
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Name | MR. JOHN HARRISON
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Credential |
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Telephone | 502-568-7338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 69001112A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | KY
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