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General NPI Number Information
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NPI Number | 1578542098
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Entity Type | Organization
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Legal Business Name | EAST TEXAS MEDICAL CENTER FAIRFIELD
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 125 NEWMAN ST
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City | FAIRFIELD
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State | TX
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Zip | 75840-1419
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Country | US
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Telephone | 903-389-2121
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1939
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City | ATHENS
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State | TX
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Zip | 75751-1939
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HOPSITAL ADMINISTRATOR
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Name | MS. RAZ COOK
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Credential |
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Telephone | 903-389-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 000401
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 000401
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 000401
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 000401
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License Number State | TX
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