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General NPI Number Information
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NPI Number | 1295930089
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTHCARE, LLC
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 1321 MCARTHUR ST STE A
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City | MANCHESTER
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State | TN
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Zip | 37355-2425
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Country | US
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Telephone | 931-728-0772
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Fax | 931-728-0444
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Provider Business Mailing Address
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Address Line | 1321 MCARTHUR ST STE A
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City | MANCHESTER
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State | TN
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Zip | 37355-2425
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Country | US
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Telephone | 931-728-0772
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Fax | 931-728-0444
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | RHONDA DYCUS
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Credential |
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Telephone | 931-728-0772
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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 | APN5896
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | DO1634
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | APN6245
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License Number State | TN
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