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General NPI Number Information
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NPI Number | 1447649009
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Entity Type | Organization
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Legal Business Name | PRAETORIAN HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 01/20/2015
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 10241 BONEY AVE SUITE A
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City | DIBERVILLE
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State | MS
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Zip | 39540-4889
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Country | US
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Telephone | 228-314-1290
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7066
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City | GULFPORT
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State | MS
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Zip | 39506-7066
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Country | US
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Telephone | 228-314-1290
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELANIE FAYARD
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Credential |
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Telephone | 228-596-5719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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