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General NPI Number Information
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NPI Number | 1972988129
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Entity Type | Organization
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Legal Business Name | MAVERON HEALTH, LLC
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 6577 HENNEMAN WAY
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City | MCKINNEY
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State | TX
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Zip | 75070-3169
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Country | US
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Telephone | 650-308-8929
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Fax | 214-481-5096
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Provider Business Mailing Address
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Address Line | 5760 LEGACY DR SUITE B3-317
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City | PLANO
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State | TX
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Zip | 75024-7102
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Country | US
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Telephone | 650-308-8929
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Fax | 214-481-5096
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Authorized Official
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Title or Position | PARTNER
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Name | MARC INGRAM
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Credential |
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Telephone | 650-308-8929
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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 | 079883974
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License Number State | TX
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