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General NPI Number Information
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NPI Number | 1306395884
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Entity Type | Organization
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Legal Business Name | AMBULATORY 22
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Dates
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Enumeration Date | 09/26/2016
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 5760 LEGACY DR SUITE B-325
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City | PLANO
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State | TX
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Zip | 75024-7102
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Country | US
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Telephone | 214-787-3881
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Fax |
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Provider Business Mailing Address
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Address Line | 5760 LEGACY DR STE B-325
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City | PLANO
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State | TX
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Zip | 75024-7102
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Country | US
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Telephone | 214-675-1881
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | MR. ANTHONY JONES
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Credential |
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Telephone | 214-675-1881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State | TX
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