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General NPI Number Information
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NPI Number | 1467958082
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Entity Type | Organization
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Legal Business Name | MEDICAL SERVICE GROUP LLC
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 11576 PIERSON RD STE K6
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City | WELLINGTON
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State | FL
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Zip | 33414-8765
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Country | US
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Telephone | 561-337-7976
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Fax |
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Provider Business Mailing Address
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Address Line | 6801 LAKE WORTH RD STE 350
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City | GREENACRES
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State | FL
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Zip | 33467-2974
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Country | US
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Telephone | 561-337-7976
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | THOMAS SMITH
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Credential |
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Telephone | 561-337-7976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 56081347114901
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License Number State | FL
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