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General NPI Number Information
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NPI Number | 1447351028
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Entity Type | Organization
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Legal Business Name | INSTACLINIC OF ILLINOIS, LLC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 2811 HOMER ADAMS PARKWAY
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City | ALTON
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State | IL
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Zip | 62002
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Country | US
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Telephone | 314-238-1275
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Fax | 314-238-1250
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Provider Business Mailing Address
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Address Line | 10805 SUNSET OFFICE DRIVE SUITE 300
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City | ST. LOUIS
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State | MO
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Zip | 63127
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Country | US
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Telephone | 314-238-1275
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Fax | 314-238-1250
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. PATRICIA M SOHN
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Credential | RN
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Telephone | 314-238-1275
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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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