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General NPI Number Information
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NPI Number | 1932323474
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Entity Type | Organization
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Legal Business Name | WINDING WATERS CLINIC PC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 203 E FIRST STREET
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City | WALLOWA
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State | OR
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Zip | 97885-9999
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Country | US
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Telephone | 541-886-2431
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Fax | 541-886-2211
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Provider Business Mailing Address
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Address Line | 406 NE 1ST ST
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City | ENTERPRISE
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State | OR
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Zip | 97828-1168
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Country | US
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Telephone | 541-886-2431
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Fax | 541-886-2211
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT K SIEBE
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Credential | MD
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Telephone | 541-886-2431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 383865
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License Number State | OR
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