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General NPI Number Information
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NPI Number | 1316456494
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Entity Type | Organization
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Legal Business Name | MAINTENANCE MATRIX, LLC
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Dates
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Enumeration Date | 09/21/2017
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Last Update Date | 09/21/2017
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Provider Practice Location Address
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Address Line | 200 S BROAD ST STE 430
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City | PHILADELPHIA
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State | PA
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Zip | 19102-3800
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Country | US
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Telephone | 786-554-1151
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Fax | 786-331-9660
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Provider Business Mailing Address
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Address Line | 1825 PONCE DELEON BLVD 612
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City | CORAL GABLES
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State | FL
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Zip | 33134
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Country | US
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Telephone | 786-551-1151
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Fax | 786-331-9660
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Authorized Official
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Title or Position | DIRECTOR, OPERATIONS
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Name | TRACY FOLLIARD
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Credential |
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Telephone | 786-554-1151
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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 |
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License Number State |
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