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General NPI Number Information
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NPI Number | 1275979031
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Entity Type | Organization
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Legal Business Name | MEMORIAL HOSPITAL ASSOCIATION
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 204 CENTER ST
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City | AUGUSTA
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State | IL
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Zip | 62311-1228
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Country | US
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Telephone | 217-392-2108
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Fax | 217-392-2110
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Provider Business Mailing Address
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Address Line | PO BOX 160
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City | CARTHAGE
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State | IL
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Zip | 62321-0160
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Country | US
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Telephone | 217-357-6512
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Fax | 217-357-6544
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Authorized Official
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Title or Position | SPECIAL PROJECTS COORDINATOR
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Name | JESSIE FIFER
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Credential |
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Telephone | 217-357-6594
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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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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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