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General NPI Number Information
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NPI Number | 1316096399
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Entity Type | Organization
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Legal Business Name | BUSHNELL FAMILY PRACTICE, SC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 11/03/2009
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Provider Practice Location Address
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Address Line | 155 W HAIL ST
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City | BUSHNELL
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State | IL
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Zip | 61422-1346
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Country | US
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Telephone | 309-772-9444
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Fax | 309-772-6446
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Provider Business Mailing Address
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Address Line | PO BOX 446
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City | MACOMB
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State | IL
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Zip | 61455-0446
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Country | US
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Telephone | 309-833-2868
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Fax | 309-836-3779
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN ARNOLD
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Credential | M.D.
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Telephone | 309-772-9444
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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 | 036062336
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License Number State | IL
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