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General NPI Number Information
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NPI Number | 1922558352
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Entity Type | Organization
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Legal Business Name | MIDTOWN INFUSION CENTER
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 1445 GEORGIA AVE STE 2
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City | MACON
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State | GA
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Zip | 31201-7610
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Country | US
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Telephone | 478-250-1325
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Fax | 478-254-6860
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Provider Business Mailing Address
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Address Line | 1445 GEORGIA AVE STE 2
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City | MACON
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State | GA
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Zip | 31201-7610
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Country | US
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Telephone | 478-250-1325
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Fax | 478-254-6860
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Authorized Official
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Title or Position | CEO
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Name | DR. REUBEN K ELLIS
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Credential | MD
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Telephone | 478-250-1325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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