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General NPI Number Information
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NPI Number | 1033866801
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Entity Type | Organization
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Legal Business Name | CARLE WEST PHYSICIAN GROUP INC
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Dates
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Enumeration Date | 03/02/2022
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Last Update Date | 03/02/2022
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Provider Practice Location Address
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Address Line | 1111 TRINITY LN STE 111
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City | BLOOMINGTON
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State | IL
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Zip | 61704-8112
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Country | US
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Telephone | 309-663-6461
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Fax |
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Provider Business Mailing Address
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Address Line | 3310 FIELDS SOUTH DR FAPC
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City | CHAMPAIGN
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State | IL
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Zip | 61822-3741
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Country | US
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Telephone | 217-902-5291
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Fax | 217-902-7711
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES C LEONARD
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Credential |
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Telephone | 217-902-5291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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