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NPI Code Detail

MEDICARE: SHERATON FULLER MHS

MEDICARE:   SHERATON  FULLER  MHS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1497120067
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHERATON FULLER MHS
Provider Business Mailing Address
First Line : 213 WASHINGTON AVE
Second Line :
City : MANSFIELD
State : LA
Zip : 71052-2605
Country : US
Telephone Number : 318-872-0262
Fax Number : 318-872-3329
Provider Business Practice Location Address
First Line : 213 WASHINGTON AVE
Second Line :
City : MANSFIELD
State : LA
Zip : 71052-2605
Country : US
Telephone Number : 318-872-0262
Fax Number : 318-872-3329
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2015
Last Update Date : 01/14/2019

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