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General NPI Number Information
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NPI Number | 1265733505
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Entity Type | Organization
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Legal Business Name | SOUTHEAST CARE AND HEALTH CENTER
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 3932 OLD SPANISH TRL STE C
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City | HOUSTON
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State | TX
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Zip | 77021-1460
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Country | US
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Telephone | 713-440-0074
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Fax | 713-440-0106
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Provider Business Mailing Address
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Address Line | 3922 OLD SPANISH TRL
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City | HOUSTON
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State | TX
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Zip | 77021-1425
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Country | US
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Telephone | 713-440-0074
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Fax | 713-440-0106
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | BENNIT E. HAYES
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Credential |
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Telephone | 713-440-0074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | TX
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