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General NPI Number Information
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NPI Number | 1043156425
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Entity Type | Organization
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Legal Business Name | INDIGENOUS HEALTHCARE ADVANCEMENTS, LLC
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 1032 SEAGATE AVE
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City | COOS BAY
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State | OR
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Zip | 97420-3055
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Country | US
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Telephone | 808-214-7269
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Fax |
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Provider Business Mailing Address
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Address Line | 675 S GREEN VALLEY PKWY # 1313
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City | HENDERSON
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State | NV
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Zip | 89052-0404
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Country | US
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Telephone | 808-214-7269
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN RANDOLPH REEVES III
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Credential | MHA
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Telephone | 808-214-7269
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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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