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General NPI Number Information
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NPI Number | 1467871913
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Entity Type | Organization
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Legal Business Name | MT. HARRISON AUDIOLOGY AND HEARING AIDS LLC
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Dates
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Enumeration Date | 04/14/2014
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 1218 9TH ST UNIT 2
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City | RUPERT
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State | ID
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Zip | 83350-2207
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Country | US
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Telephone | 208-312-0957
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Fax |
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Provider Business Mailing Address
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Address Line | 1218 9TH ST UNIT 2
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City | RUPERT
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State | ID
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Zip | 83350-2207
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Country | US
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Telephone | 208-312-0957
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. CHRISTINE WILCOX PICKUP
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Credential | AUD
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Telephone | 208-312-0957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | AUD-1529
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License Number State | ID
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