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General NPI Number Information
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NPI Number | 1306016274
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Entity Type | Organization
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Legal Business Name | GENESIS MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 220 W CEDAR ST
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City | SHELBYVILLE
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State | TN
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Zip | 37160-2838
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Country | US
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Telephone | 931-684-4153
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Fax | 888-371-5180
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Provider Business Mailing Address
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Address Line | 220 W CEDAR ST
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City | SHELBYVILLE
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State | TN
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Zip | 37160-2838
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Country | US
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Telephone | 931-684-4153
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Fax | 888-371-5180
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Authorized Official
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Title or Position | SOLE PROPRIETOR PHYSICIAN
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Name | ALMA M TAMULA
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Credential | MD
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Telephone | 931-684-4153
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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 |
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License Number State |
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