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General NPI Number Information
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NPI Number | 1851491666
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Entity Type | Organization
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Legal Business Name | ST LUKES METHODIST HOSPITAL
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 9255 ATLANTIC DR SW
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City | CEDAR RAPIDS
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State | IA
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Zip | 52404-8950
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Country | US
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Telephone | 319-396-1386
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Fax | 319-363-3041
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Provider Business Mailing Address
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Address Line | 9255 ATLANTIC DR SW
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City | CEDAR RAPIDS
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State | IA
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Zip | 52404-8950
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Country | US
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Telephone | 319-396-1386
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Fax | 319-363-3041
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Authorized Official
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Title or Position | OWNER
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Name | JOEY MUSICK
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Credential |
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Telephone | 319-558-6317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 438
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License Number State | IA
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