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General NPI Number Information
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NPI Number | 1659431690
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Entity Type | Organization
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Legal Business Name | CPC REFERENCE LABS
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 111 W BANKHEAD ST
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City | NEW ALBANY
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State | MS
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Zip | 38652-3314
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Country | US
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Telephone | 662-538-5794
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Fax | 662-538-5796
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Provider Business Mailing Address
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Address Line | PO BOX 2368
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City | NEW ALBANY
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State | MS
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Zip | 38652-2475
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Country | US
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Telephone | 662-538-5794
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Fax | 662-538-5796
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | MR. JOSEPH R CAMPBELL
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Credential |
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Telephone | 662-538-5794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | MS
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