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General NPI Number Information
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NPI Number | 1902913643
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Entity Type | Organization
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Legal Business Name | ST MARYS MEDICAL CENTER PLC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 03/05/2010
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Provider Practice Location Address
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Address Line | 430 WEST STUART DRIVE
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City | HILLSVILLE
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State | VA
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Zip | 24343
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Country | US
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Telephone | 276-728-3332
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Fax | 276-728-3302
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Provider Business Mailing Address
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Address Line | PO BOX 1805
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City | HILLSVILLE
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State | VA
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Zip | 24343
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Country | US
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Telephone | 276-728-3332
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Fax | 276-728-3302
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Authorized Official
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Title or Position | OWNER
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Name | MR. MEDHAT N ELMASRY
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Credential | MD
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Telephone | 276-728-3332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101054724
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License Number State | VA
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