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General NPI Number Information
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NPI Number | 1295488195
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Entity Type | Organization
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Legal Business Name | HOMETOWN MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 2195 N CITATION AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65802-5420
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Country | US
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Telephone | 417-476-6033
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Fax | 417-429-4543
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Provider Business Mailing Address
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Address Line | 2195 N CITATION AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65802-5420
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Country | US
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Telephone | 417-476-6033
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Fax | 417-429-4543
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | LESLIE ALEXANDER
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Credential |
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Telephone | 301-661-3481
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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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