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General NPI Number Information
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NPI Number | 1487348389
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Entity Type | Organization
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Legal Business Name | WILDFLOWER RIVERHOUSE LLC
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 1415 OLIVE ST
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City | SAINT JOSEPH
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State | MO
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Zip | 64503-2443
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Country | US
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Telephone | 816-273-5070
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Fax | 816-273-5070
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Provider Business Mailing Address
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Address Line | 3831 FREDERICK AVE # 106
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-3020
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Country | US
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Telephone | 816-248-2144
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PATRICK E GAUME
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Credential |
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Telephone | 816-248-2144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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