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General NPI Number Information
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NPI Number | 1851551386
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Entity Type | Organization
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Legal Business Name | SELF RELIANCE LLC
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 03/31/2009
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Provider Practice Location Address
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Address Line | 500 S UNIVERSITY AVE SUITE A-14
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5302
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Country | US
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Telephone | 501-671-6200
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Fax | 501-671-6205
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Provider Business Mailing Address
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Address Line | 500 S UNIVERSITY AVE SUITE A-14
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5302
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Country | US
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Telephone | 501-671-6200
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Fax | 501-671-6205
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MAGOMED KHAIDAKOV
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Credential |
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Telephone | 501-658-8057
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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 |
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License Number State |
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