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General NPI Number Information
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NPI Number | 1649139031
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Entity Type | Individual
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Provider Name | MATTHEW WILLIAM MCMICKEN CSFA
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Gender | Male
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Dates
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Enumeration Date | 01/20/2026
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 13710 ST FRANCIS BLVD
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City | MIDLOTHIAN
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State | VA
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Zip | 23114-3267
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Country | US
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Telephone | 804-594-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 145 COUNTY ROAD 407
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City | CULLMAN
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State | AL
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Zip | 35057-1247
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Country | US
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Telephone | 205-260-7273
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 0136000664
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License Number State | VA
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