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General NPI Number Information
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NPI Number | 1942509427
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Entity Type | Organization
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Legal Business Name | MIDTOWN
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Dates
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Enumeration Date | 03/23/2011
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 1001 W 10TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-2859
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Country | US
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Telephone | 317-630-8839
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Fax |
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Provider Business Mailing Address
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Address Line | 877 SABLE RIDGE DR
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City | GREENWOOD
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State | IN
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Zip | 46142-9767
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Country | US
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Telephone | 317-447-8186
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Fax |
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Authorized Official
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Title or Position | CIU SPEACILIST
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Name | JENNIE A CAMPBELL
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Credential | LCSW
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Telephone | 317-630-8839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 34006177A
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License Number State | IN
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