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General NPI Number Information
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NPI Number | 1548552284
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Entity Type | Organization
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Legal Business Name | PRI-MED FAMILY & PEEDIATRIC CLINIC LLC
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Dates
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Enumeration Date | 05/13/2011
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Last Update Date | 05/13/2011
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Provider Practice Location Address
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Address Line | 12221 S KIRKWOOD RD SUITE 100
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City | STAFFORD
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State | TX
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Zip | 77477-3044
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Country | US
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Telephone | 713-303-9064
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Fax |
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Provider Business Mailing Address
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Address Line | 12221 S KIRKWOOD RD
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City | STAFFORD
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State | TX
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Zip | 77477-3044
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Country | US
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Telephone | 713-303-9064
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Fax | 713-641-6601
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LAURA N KANU
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Credential | RN, MSN, FNP-C
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Telephone | 713-303-9064
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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 | 595403
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License Number State | TX
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