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General NPI Number Information
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NPI Number | 1205817319
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Entity Type | Organization
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Legal Business Name | MARSHALL RURAL HEALTH CLINIC
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 703 S WASHINGTON AVE
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City | MARSHALL
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State | TX
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Zip | 75670-5337
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Country | US
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Telephone | 903-927-6140
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Fax | 903-927-6117
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Provider Business Mailing Address
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Address Line | 7914 FM-9 SOUTH
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City | WASKOM
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State | TX
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Zip | 75692-7914
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Country | US
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Telephone | 903-633-2802
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MR. DWIGHT RAYMOND CLEMANS
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Credential | FNP-C
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Telephone | 903-927-6140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 623027
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License Number State | TX
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