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General NPI Number Information
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NPI Number | 1821436155
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Entity Type | Organization
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Legal Business Name | PRIME CARE MEDICAL CENTER LLC
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Dates
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Enumeration Date | 06/09/2013
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Last Update Date | 06/09/2013
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Provider Practice Location Address
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Address Line | 203 W LEE ST
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City | TUSKEGEE
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State | AL
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Zip | 36083-1719
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Country | US
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Telephone | 334-663-3587
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Fax | 334-821-6287
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Provider Business Mailing Address
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Address Line | 2220 MT VERNON LN
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City | AUBURN
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State | AL
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Zip | 36830-4257
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Country | US
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Telephone | 334-821-6287
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | FAZLE MATIN
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Credential | MD
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Telephone | 334-663-3587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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