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General NPI Number Information
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NPI Number | 1528273315
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Entity Type | Organization
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Legal Business Name | CUMMINGS HEALTH CARE CENTER
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 536 S CHOCTAW ST
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City | CLARKSDALE
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State | MS
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Zip | 38614-4800
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Country | US
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Telephone | 662-627-4442
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Fax | 662-627-9665
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Provider Business Mailing Address
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Address Line | PO BOX 1610 536 CHOCTAW STREET
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City | CLARKSDALE
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State | MS
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Zip | 38614-8410
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Country | US
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Telephone | 662-627-4442
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Fax | 662-627-9665
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHNNIE E CUMMINGS III
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Credential | M.D.
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Telephone | 662-627-4442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 12250
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License Number State | MS
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