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General NPI Number Information
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NPI Number | 1215208632
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Entity Type | Organization
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Legal Business Name | AMBULATORY CARE CLINIC L.L.C
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Dates
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Enumeration Date | 01/17/2012
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 1619 SIXTH ST
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City | ST THOMAS
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State | VI
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Zip | 00802-2635
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Country | US
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Telephone | 340-643-7233
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Fax |
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Provider Business Mailing Address
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Address Line | 1619 SIXTH ST
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City | ST THOMAS
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State | VI
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Zip | 00802-2635
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Country | US
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Telephone | 340-643-7233
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Fax |
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Authorized Official
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Title or Position | MEMBER-MANAGER
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Name | DR. ELIZABETH FLOWER
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Credential | M.D
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Telephone | 340-642-7233
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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 | 1-16363-1L
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License Number State | VI
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