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General NPI Number Information
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NPI Number | 1467631861
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Entity Type | Organization
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Legal Business Name | PROMED WALK IN CLINIC INC
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 1703 SW 2ND AVE
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City | OKEECHOBEE
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State | FL
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Zip | 34974-6169
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Country | US
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Telephone | 863-467-7377
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Fax |
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Provider Business Mailing Address
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Address Line | 1703 SW 2ND AVE
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City | OKEECHOBEE
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State | FL
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Zip | 34974-6169
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Country | US
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Telephone | 863-467-7377
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CAROL LYNN JOHNS
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Credential |
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Telephone | 863-467-7377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ARNP3141172
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License Number State | FL
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