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General NPI Number Information
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NPI Number | 1619327376
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Entity Type | Organization
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Legal Business Name | CA GROUP, LLC
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 1404 CROSS ST SUITE 2940
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City | SHILOH
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State | IL
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Zip | 62269-2988
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Country | US
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Telephone | 618-607-3700
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Fax | 618-624-4841
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Provider Business Mailing Address
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Address Line | 4500 MEMORIAL DRIVE MEMORIAL HOSPITAL CREDENTIALING DEPARTMENT
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City | BELLEVILLE
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State | IL
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Zip | 62226
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Country | US
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Telephone | 618-257-4644
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Fax | 618-257-6946
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JAMES B DAVIS
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Credential |
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Telephone | 618-257-4644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State |
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