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General NPI Number Information
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NPI Number | 1356524698
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Entity Type | Organization
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Legal Business Name | WEST BELLFORT LLC
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 900 WAYSIDE
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City | HOUSTON
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State | TX
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Zip | 77011-2518
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Country | US
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Telephone | 713-921-7246
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Fax | 713-921-7249
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Provider Business Mailing Address
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Address Line | 900 WAYSIDE
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City | HOUSTON
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State | TX
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Zip | 77011-2518
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Country | US
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Telephone | 281-646-1935
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Fax | 281-646-0927
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Authorized Official
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Title or Position | CRED SUP
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Name | MS. SANDRA ANN SHIRAH
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Credential |
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Telephone | 281-646-1935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | F6356
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License Number State | TX
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