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General NPI Number Information
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NPI Number | 1275278574
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Entity Type | Organization
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Legal Business Name | INTENSIVE CARE CONSORTIUM - MIDWEST, LLC
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 550 N HILLSIDE ST
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City | WICHITA
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State | KS
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Zip | 67214-4910
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Country | US
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Telephone | 316-962-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 HEALTH PARK DR
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City | BRENTWOOD
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State | TN
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Zip | 37027-4692
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Country | US
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Telephone | 615-373-7406
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLOS MOAS
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Credential |
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Telephone | 786-494-5154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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