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General NPI Number Information
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NPI Number | 1710046958
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Entity Type | Organization
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Legal Business Name | MOUNTAIN STREAMS MEDICAL CENTER PC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 2155 HOLLOW BROOK DR STE 60
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-1455
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Country | US
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Telephone | 719-536-4831
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Fax | 719-536-4814
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Provider Business Mailing Address
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Address Line | PO BOX 820
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City | CASTLE ROCK
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State | CO
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Zip | 80104-0820
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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 | PRESIDENT
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Name | DR. SCOTT B WOODY
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Credential | DO
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Telephone | 719-321-6974
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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 | 39735
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License Number State | CO
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