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General NPI Number Information
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NPI Number | 1649613621
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Entity Type | Organization
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Legal Business Name | MIDLANDS MEDICAL WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 04/09/2013
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Provider Practice Location Address
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Address Line | 200 SPRINGTREE DR SUITE 200
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City | COLUMBIA
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State | SC
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Zip | 29223-8614
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Country | US
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Telephone | 803-223-9328
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Fax |
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Provider Business Mailing Address
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Address Line | 205 WATER HICKORY WAY
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City | COLUMBIA
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State | SC
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Zip | 29229-7550
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JANDRETTE RHOE
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Credential | MD
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Telephone | 803-223-9328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 22453
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License Number State | SC
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