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General NPI Number Information
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NPI Number | 1629704069
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Entity Type | Organization
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Legal Business Name | VILLAGE MEDICAL CENTER LLC
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 266 W 3RD ST REAR
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City | FRAZEYSBURG
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State | OH
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Zip | 43822-9784
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Country | US
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Telephone | 740-334-9480
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Fax |
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Provider Business Mailing Address
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Address Line | 13260 SCOUT RD
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City | FRAZEYSBURG
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State | OH
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Zip | 43822-9372
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Country | US
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Telephone | 740-334-9480
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FELISHA WOLFORD
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Credential | CNP
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Telephone | 740-334-9480
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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 |
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License Number State |
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