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General NPI Number Information
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NPI Number | 1396022034
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Entity Type | Organization
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Legal Business Name | MAIN STREET CLINIC, LLC
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 115 MAIN ST
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City | COLUMBIA
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State | LA
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Zip | 71418
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Country | US
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Telephone | 318-649-3668
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1615
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City | COLUMBIA
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State | LA
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Zip | 71418-1615
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Country | US
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Telephone | 318-649-3668
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Fax | 318-649-0086
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Authorized Official
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Title or Position | OWNER, PROVIDER
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Name | MS. LAURA G CUMMINGS
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Credential | FNP
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Telephone | 318-649-3668
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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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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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