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General NPI Number Information
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NPI Number | 1821152596
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Entity Type | Organization
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Legal Business Name | MEADOWS HEALTHCARE ALLIANCE
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 1107 E 1ST ST
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City | VIDALIA
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State | GA
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Zip | 30474-4205
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Country | US
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Telephone | 912-537-6930
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Fax | 912-537-6934
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Provider Business Mailing Address
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Address Line | 1107 E 1ST ST PO BOX 1915
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City | VIDALIA
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State | GA
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Zip | 30474-4205
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Country | US
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Telephone | 912-537-6930
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Fax | 912-537-6934
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. JOHN RICHARD CORNELL
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Credential |
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Telephone | 912-538-5881
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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 | 2006000651
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 2006000651
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License Number State | GA
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