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General NPI Number Information
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NPI Number | 1073072815
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Entity Type | Organization
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Legal Business Name | CONCIERGE CLINIC LLC
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 1224 S RIVER RD STE B101
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City | ST GEORGE
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State | UT
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Zip | 84790-8365
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Country | US
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Telephone | 435-236-0835
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 W INDIAN HILLS DR UNIT 46
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City | ST GEORGE
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State | UT
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Zip | 84770-1939
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Country | US
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Telephone | 435-669-6603
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RAY KLAWITTER
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Credential |
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Telephone | 435-236-0835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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