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General NPI Number Information
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NPI Number | 1720073638
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Entity Type | Organization
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Legal Business Name | WELLPOINTE FAMILY MEDICAL
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 543 W HUBBLE DR
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City | MARSHFIELD
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State | MO
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Zip | 65706-1532
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Country | US
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Telephone | 417-859-7746
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Fax | 417-859-7411
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Provider Business Mailing Address
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Address Line | PO BOX 817
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63702-0817
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Country | US
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Telephone | 573-335-4715
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Fax | 573-334-2303
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Authorized Official
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Title or Position | PHD PRESIDENT
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Name | WARD M LAWSON
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Credential | PHD
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Telephone | 417-859-7746
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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