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General NPI Number Information
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NPI Number | 1851235204
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Entity Type | Organization
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Legal Business Name | CORE HEALTH SYSTEMS
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Dates
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Enumeration Date | 04/16/2026
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Last Update Date | 04/16/2026
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Provider Practice Location Address
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Address Line | 1113 N WALCOTT ST STE B
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City | JEFFERSON
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State | TX
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Zip | 75657-1034
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Country | US
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Telephone | 903-758-2471
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Fax | 903-234-1639
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Provider Business Mailing Address
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Address Line | 107 WOODBINE PL
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City | LONGVIEW
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State | TX
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Zip | 75601-2912
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Country | US
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Telephone | 903-758-2471
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Fax | 903-234-1639
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT/CRED SPECIALIST
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Name | ROSEMARY O VILLARREAL
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Credential | PESC
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Telephone | 903-932-3779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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