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General NPI Number Information
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NPI Number | 1811391279
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Entity Type | Organization
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Legal Business Name | CENTRA CLINIC, INC
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 16316 FM 529 RD
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City | HOUSTON
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State | TX
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Zip | 77095-1464
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Country | US
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Telephone | 812-861-0600
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Fax | 812-861-7292
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Provider Business Mailing Address
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Address Line | 16316 FM 529 RD
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City | HOUSTON
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State | TX
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Zip | 77095-1464
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Country | US
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Telephone | 812-861-0600
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Fax | 812-861-7292
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. YAA O HONNY
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Credential | M.D.
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Telephone | 832-328-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AP126663
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License Number State | TX
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