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General NPI Number Information
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NPI Number | 1649632951
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Entity Type | Organization
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Legal Business Name | MEMORIAL FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 03/25/2016
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Provider Practice Location Address
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Address Line | 3627 UNIVERSITY BLVD S SUITE 235
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4230
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Country | US
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Telephone | 904-702-6353
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Fax | 904-702-6356
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Provider Business Mailing Address
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Address Line | 3627 UNIVERSITY BLVD S SUITE 235
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4230
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Country | US
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Telephone | 904-702-6353
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Fax | 904-702-6356
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Authorized Official
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Title or Position | CHARGE ENTRY SPECIALIST
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Name | MRS. MELISSA DAWN BOYD
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Credential |
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Telephone | 904-702-5353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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