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General NPI Number Information
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NPI Number | 1497819494
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY MEDICAL CARE, LLC
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12597 OLIVE BLVD
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City | CREVE COEUR
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State | MO
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Zip | 63141-6311
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Country | US
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Telephone | 618-779-5508
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Fax | 618-206-8588
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Provider Business Mailing Address
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Address Line | 12597 OLIVE BLVD
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City | CREVE COEUR
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State | MO
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Zip | 63141-6311
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Country | US
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Telephone | 618-779-5508
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Fax | 618-206-8588
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Authorized Official
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Title or Position | BUSINESS ADVISOR
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Name | MS. JERRIE K WEITH
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Credential | FHFMA
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Telephone | 618-779-5508
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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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