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General NPI Number Information
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NPI Number | 1396169587
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Entity Type | Organization
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Legal Business Name | MOBILE MEDICAL CARE
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 2504 CAYER LN SUITE C
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City | COLUMBIA
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State | TN
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Zip | 38401-7383
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Country | US
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Telephone | 615-624-1613
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 210929
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City | NASHVILLE
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State | TN
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Zip | 37221-0929
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Country | US
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Telephone | 615-624-1613
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MEKONNEN S KIDANE
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Credential | DNP
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Telephone | 615-624-1613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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