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General NPI Number Information
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NPI Number | 1265869143
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Entity Type | Organization
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Legal Business Name | FEASTER TRAIL EMERGENCY PHYSICIANS, LLC
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Dates
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Enumeration Date | 10/09/2013
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 3050 TWIN RIVERS DR
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City | ARKADELPHIA
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State | AR
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Zip | 71923-4218
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Country | US
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Telephone | 870-245-2622
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Fax |
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Provider Business Mailing Address
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Address Line | 350 W CEDAR ST FL 4
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City | PENSACOLA
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State | FL
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Zip | 32502-4910
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Country | US
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Telephone | 954-838-2371
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | KATHLEEN KONDAS
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Credential |
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Telephone | 954-838-2371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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