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General NPI Number Information
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NPI Number | 1740708882
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Entity Type | Organization
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Legal Business Name | CM RESORT, LLC
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Dates
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Enumeration Date | 09/08/2017
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Last Update Date | 09/08/2017
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Provider Practice Location Address
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Address Line | 239 SKIMOBILE ROAD
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City | NORTH CONWAY
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State | NH
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Zip | 03860
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Country | US
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Telephone | 603-356-5544
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Fax | 603-356-8526
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Provider Business Mailing Address
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Address Line | P.O. BOX 1640
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City | NORTH CONWAY
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State | NH
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Zip | 03860
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Country | US
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Telephone | 603-356-5544
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Fax | 603-356-8526
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Authorized Official
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Title or Position | PRESIDENT/GM
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Name | BEN WILCOX
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Credential |
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Telephone | 603-356-5544
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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 | 1051-001
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License Number State | NH
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