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General NPI Number Information
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NPI Number | 1487145835
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Entity Type | Organization
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Legal Business Name | BYRD FAMILY MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 14 E TUMBLEWEED LN
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City | TAYLOR
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State | AZ
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Zip | 85939
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Country | US
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Telephone | 928-457-2019
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Fax | 833-944-1884
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Provider Business Mailing Address
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Address Line | PO BOX 1295
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City | TAYLOR
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State | AZ
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Zip | 85939-1295
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Country | US
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Telephone | 928-243-8377
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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 | RONALD J BYRD
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Credential | FMP
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Telephone | 928-457-2019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AP3061
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License Number State | AZ
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