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General NPI Number Information
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NPI Number | 1548422462
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Entity Type | Organization
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Legal Business Name | AMBULATORY CARE CLINIC OF IONIA PC
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 3015 S STATE RD
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City | IONIA
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State | MI
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Zip | 48846-9416
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Country | US
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Telephone | 616-522-9110
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Fax | 616-522-9114
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Provider Business Mailing Address
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Address Line | 3015 S STATE RD
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City | IONIA
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State | MI
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Zip | 48846-9416
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Country | US
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Telephone | 616-522-9110
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Fax | 616-522-9114
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TERESA SMITH
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Credential |
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Telephone | 616-522-9110
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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 | 4301063290
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License Number State | MI
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