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General NPI Number Information
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NPI Number | 1164567426
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Entity Type | Organization
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Legal Business Name | WINDY CITY MEDICAL CLINIC PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 500 S 7TH AVE STE A
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City | BARSTOW
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State | CA
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Zip | 92311-3057
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Country | US
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Telephone | 760-255-2400
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Fax | 760-957-7517
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Provider Business Mailing Address
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Address Line | PO BOX 1946
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City | BARSTOW
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State | CA
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Zip | 92312-1946
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Country | US
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Telephone | 760-255-2400
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Fax | 760-957-7517
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Authorized Official
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Title or Position | BILLING OFFICE MANAGER
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Name | MS. KATHY A ALVA
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Credential |
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Telephone | 760-403-8758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | CA
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