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General NPI Number Information
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NPI Number | 1437268604
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Entity Type | Organization
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Legal Business Name | SPOON RIVER FAMILY PRACTICE CENTER, INC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 45 E SIDE SQ SUITE 102
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City | CANTON
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State | IL
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Zip | 61520-2671
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Country | US
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Telephone | 309-647-9980
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Fax | 309-647-7792
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Provider Business Mailing Address
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Address Line | 45 E SIDE SQ SUITE 102
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City | CANTON
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State | IL
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Zip | 61520-2671
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Country | US
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Telephone | 309-647-9980
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LINDA KAY FORESTIER
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Credential | M.D.
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Telephone | 309-647-9980
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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 | IL
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