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General NPI Number Information
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NPI Number | 1831737303
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Entity Type | Organization
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Legal Business Name | REPOWER MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 12/16/2019
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 7254 E SOUTHERN AVE STE 113
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City | MESA
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State | AZ
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Zip | 85209-2787
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Country | US
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Telephone | 480-588-2233
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Fax | 480-588-2235
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Provider Business Mailing Address
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Address Line | 7254 E SOUTHERN AVE STE 113
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City | MESA
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State | AZ
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Zip | 85209-2787
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Country | US
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Telephone | 480-588-2233
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Fax | 480-588-2235
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Authorized Official
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Title or Position | OWNER
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Name | DR. DONESE WORDEN
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Credential | NMD
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Telephone | 480-231-0640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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