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General NPI Number Information
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NPI Number | 1700056587
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Entity Type | Organization
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Legal Business Name | BONNEY LAKE MEDICAL CENTER
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 20631 HWY 410 E. STE 303
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City | BONNEY LAKE
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State | WA
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Zip | 98390-6390
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Country | US
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Telephone | 253-891-2160
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Fax | 253-891-2171
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Provider Business Mailing Address
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Address Line | 20631 HWY 410 E. STE 303
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City | BONNEY LAKE
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State | WA
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Zip | 98390-6390
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Country | US
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Telephone | 253-891-2160
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Fax | 253-891-2171
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Authorized Official
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Title or Position | OWNER
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Name | DR. MYTHILI R ARIGALA
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Credential | M.D.
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Telephone | 253-891-2160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD00036489
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License Number State | WA
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