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General NPI Number Information
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NPI Number | 1639349681
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Entity Type | Organization
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Legal Business Name | DELTA MEDICAL SERVICES
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 1800 BUCKNER ST STE B210
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City | SHREVEPORT
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State | LA
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Zip | 71101-4438
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Country | US
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Telephone | 318-459-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 BUCKNER ST STE B210
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City | SHREVEPORT
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State | LA
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Zip | 71101-4438
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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 | PRESIDENT/CEO
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Name | MRS. DORIS MITCHELL
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Credential |
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Telephone | 318-459-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number | 11385
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License Number State | LA
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