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General NPI Number Information
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NPI Number | 1902579477
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Entity Type | Organization
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Legal Business Name | SOLACE FAMILY HEALTHCARE
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | 925 BISHOP WALSH RD STE 7
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City | CUMBERLAND
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State | MD
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Zip | 21502-1845
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Country | US
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Telephone | 304-698-7030
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Fax |
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Provider Business Mailing Address
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Address Line | 39 SAMPSON ROCK RD
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City | FROSTBURG
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State | MD
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Zip | 21532-4112
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Country | US
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Telephone | 303-046-9870
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRACY UNDERWOOD
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Credential | MSN, FNP-BC
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Telephone | 304-698-7030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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