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General NPI Number Information
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NPI Number | 1861577942
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Entity Type | Organization
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Legal Business Name | CENTRAL MO WOMENS HEALTHCARE LLC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 268 S JEFFERSON
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City | MARSHALL
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State | MO
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Zip | 65340-2135
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Country | US
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Telephone | 660-886-2842
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Fax |
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Provider Business Mailing Address
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Address Line | 268 S JEFFERSON AVE
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City | MARSHALL
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State | MO
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Zip | 65340
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Country | US
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Telephone | 660-886-2842
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Fax | 660-886-8119
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Authorized Official
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Title or Position | CFO/OFFICE MANAGER
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Name | MICHELLE MCCOY
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Credential |
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Telephone | 660-886-2842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 105156
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License Number State | MO
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Taxonomy #2
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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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