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General NPI Number Information
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NPI Number | 1548567191
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Entity Type | Organization
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Legal Business Name | FAITH MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 845 NW 119TH ST SUITE B
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City | NORTH MIAMI
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State | FL
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Zip | 33168-2336
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Country | US
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Telephone | 305-685-8001
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Fax | 305-685-8024
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Provider Business Mailing Address
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Address Line | 845 NW 119TH ST SUITE B
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City | NORTH MIAMI
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State | FL
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Zip | 33168-2336
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Country | US
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Telephone | 305-685-8001
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Fax | 305-685-8024
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHATARIA BRIDGES-MOSS
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Credential |
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Telephone | 305-685-8001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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