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General NPI Number Information
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NPI Number | 1316205206
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Entity Type | Organization
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Legal Business Name | THEODOSIA FAMILY MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | 4900 ST HWY. 160 SUITE 2
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City | THEODOSIA
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State | MO
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Zip | 65761-6539
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Country | US
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Telephone | 417-273-2300
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Fax | 417-273-2316
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Provider Business Mailing Address
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Address Line | 4900 ST HWY 160 SUITE 2
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City | THEODOSIA
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State | MO
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Zip | 65761-6539
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Country | US
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Telephone | 417-273-2300
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Fax | 417-273-2316
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Authorized Official
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Title or Position | OWNER OF CLINIC
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Name | LISA A SCHOFIELD
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Credential |
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Telephone | 417-273-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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