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General NPI Number Information
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NPI Number | 1346364718
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Entity Type | Organization
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Legal Business Name | BELOIT CLINIC, S.C.
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1701 BLACKHAWK BLVD
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City | SOUTH BELOIT
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State | IL
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Zip | 61080-2407
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Country | US
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Telephone | 608-364-1348
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Fax | 608-364-2338
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Provider Business Mailing Address
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Address Line | 1905 E HUEBBE PKWY
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City | BELOIT
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State | WI
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Zip | 53511-1842
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Country | US
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Telephone | 608-364-1348
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Fax | 608-364-2338
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Authorized Official
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Title or Position | ASSISTANT ADMINISTRATOR
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Name | RUTH GRAY
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Credential |
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Telephone | 608-364-1348
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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 | WI
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