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General NPI Number Information
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NPI Number | 1255367934
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE MEDICAL CENTER
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 S 8TH ST STE 480W
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City | MURRAY
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State | KY
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Zip | 42071-2400
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Country | US
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Telephone | 270-759-9200
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Fax | 270-759-9966
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Provider Business Mailing Address
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Address Line | 300 S 8TH ST STE 480W
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City | MURRAY
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State | KY
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Zip | 42071-2400
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGED CARE SPEC ALLSCRIPTS
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Name | DIRENDIA SHACKELFORD
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Credential |
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Telephone | 800-654-0889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 22158
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License Number State | KY
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