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General NPI Number Information
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NPI Number | 1992149322
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Entity Type | Organization
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Legal Business Name | SANTIAM MEDICAL GROUP LLC
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 1401 N 10TH AVE
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City | STAYTON
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State | OR
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Zip | 97383-1311
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Country | US
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Telephone | 503-769-2175
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Fax | 503-769-5877
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Provider Business Mailing Address
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Address Line | 1401 N 10TH AVE
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City | STAYTON
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State | OR
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Zip | 97383-1311
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Country | US
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Telephone | 503-769-2175
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Fax | 503-769-5877
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Authorized Official
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Title or Position | CFO/COO
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Name | MAGGIE HUDSON
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Credential |
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Telephone | 503-769-9236
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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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