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General NPI Number Information
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NPI Number | 1366363368
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Entity Type | Organization
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Legal Business Name | PCG GROUP, LLC
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Dates
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Enumeration Date | 07/24/2026
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Last Update Date | 07/24/2026
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Provider Practice Location Address
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Address Line | 216 ADAM CIR
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City | RUSTON
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State | LA
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Zip | 71270-1613
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Country | US
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Telephone | 318-957-9744
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Fax | 318-497-7512
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Provider Business Mailing Address
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Address Line | 216 ADAM CIR
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City | RUSTON
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State | LA
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Zip | 71270-1613
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Country | US
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Telephone | 318-957-9744
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Fax | 318-497-7512
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | PHYLLIS GOINS
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Credential |
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Telephone | 318-957-9744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number |
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License Number State |
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