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General NPI Number Information
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NPI Number | 1730046764
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Entity Type | Organization
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Legal Business Name | MEDCENTER FAYETTE
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Dates
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Enumeration Date | 01/09/2026
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 122 17TH CT NE
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City | FAYETTE
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State | AL
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Zip | 35555-1353
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Country | US
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Telephone | 205-932-7777
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Fax | 205-932-8880
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Provider Business Mailing Address
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Address Line | 122 17TH CT NE
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City | FAYETTE
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State | AL
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Zip | 35555-1353
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Country | US
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Telephone | 205-932-7777
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Fax | 205-932-8880
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | BETH KOHN
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Credential |
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Telephone | 727-776-9642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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