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General NPI Number Information
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NPI Number | 1750736161
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Entity Type | Individual
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Provider Name | MICHAEL SMITH
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Gender | Male
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 5703 N BROADWAY ST
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City | KNOXVILLE
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State | TN
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Zip | 37918-4141
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Country | US
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Telephone | 865-686-0000
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Fax | 865-689-4805
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Provider Business Mailing Address
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Address Line | 5703 N. BROADWAY STREET
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City | KNOXVILLE
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State | TN
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Zip | 37918
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Country | US
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Telephone | 865-686-0000
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Fax | 865-689-4805
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 102854128
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License Number State | TN
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