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General NPI Number Information
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NPI Number | 1790188043
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Entity Type | Organization
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Legal Business Name | EMURGENT CARE LLC
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 109B E ELLENDALE AVE
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City | DALLAS
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State | OR
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Zip | 97338-1794
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Country | US
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Telephone | 503-837-2704
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Fax |
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Provider Business Mailing Address
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Address Line | 109B E ELLENDALE AVE
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City | DALLAS
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State | OR
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Zip | 97338-1794
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Country | US
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Telephone | 503-837-2704
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. HAL A MITCHELL
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Credential | D.O.
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Telephone | 503-437-3594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 201400303NP-PP
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License Number State | OR
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