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General NPI Number Information
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NPI Number | 1619326048
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Entity Type | Organization
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Legal Business Name | ICON MEDICAL SOLUTIONS CORP
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 40 SPRUCE ST STE 202
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City | LEOMINSTER
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State | MA
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Zip | 01453
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Country | US
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Telephone | 702-521-1133
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Fax |
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Provider Business Mailing Address
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Address Line | 40 SPRUCE ST STE 202
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City | LEOMINSTER
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State | MA
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Zip | 01453-3367
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRYAN BOURGEOIS
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Credential |
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Telephone | 978-534-6590
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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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