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General NPI Number Information
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NPI Number | 1740862580
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Entity Type | Organization
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Legal Business Name | COALESCE MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 1696 WEST BROAD STREET
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City | COOKEVILLE
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State | TN
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Zip | 38501
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Country | US
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Telephone | 931-486-3345
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 104
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City | BAXTER
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State | TN
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Zip | 38544-0104
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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 | CEO
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Name | KATHRYN DUBRAY
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Credential |
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Telephone | 931-322-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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