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General NPI Number Information
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NPI Number | 1780827717
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Entity Type | Organization
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Legal Business Name | ASSURED MEDICAL GROUP, INC
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 200 AMERICAN LEGION DR
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City | RAYNE
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State | LA
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Zip | 70578-5826
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Country | US
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Telephone | 337-654-5871
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Fax | 225-208-1415
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Provider Business Mailing Address
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Address Line | 139 JAMES COMEAUX RD STE B NO 575
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City | LAFAYETTE
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State | LA
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Zip | 70508-3376
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Country | US
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Telephone | 337-654-5871
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Fax | 122-520-8141
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. THOMAS L EWING
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Credential |
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Telephone | 337-654-5871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | PCA 15206
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License Number State | LA
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