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General NPI Number Information
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NPI Number | 1447596580
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL HEALTHCARE CENTER PSC
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Dates
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Enumeration Date | 12/18/2012
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 477 CAPP HARLAN RD
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City | TOMPKINSVILLE
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State | KY
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Zip | 42167-1808
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Country | US
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Telephone | 270-487-0701
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Fax | 270-487-0800
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Provider Business Mailing Address
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Address Line | 477 CAPP HARLAN RD
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City | TOMPKINSVILLE
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State | KY
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Zip | 42167-1808
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Country | US
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Telephone | 270-487-0701
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Fax | 270-487-0800
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Authorized Official
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Title or Position | OWNER
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Name | CLELLA L HAYES
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Credential | MD
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Telephone | 270-487-0701
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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 |
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