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General NPI Number Information
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NPI Number | 1841314382
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Entity Type | Organization
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Legal Business Name | WESTERN ILLINOIS SURGICAL ASSOCIATES, S.C.
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | 515 E GRANT ST STE 211
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City | MACOMB
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State | IL
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Zip | 61455-3378
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Country | US
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Telephone | 309-833-3706
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Fax |
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Provider Business Mailing Address
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Address Line | 515 E GRANT ST STE 211
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City | MACOMB
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State | IL
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Zip | 61455-3378
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Country | US
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Telephone | 309-833-3706
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDWIN L CARD
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Credential | M.D.
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Telephone | 309-833-3706
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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 |
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License Number State | IL
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