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General NPI Number Information
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NPI Number | 1649113028
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Entity Type | Organization
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Legal Business Name | ICONIC HEALTHCARE, LLC
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Dates
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Enumeration Date | 04/10/2026
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Last Update Date | 04/10/2026
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Provider Practice Location Address
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Address Line | 1810 LINDBERG DR STE 2400
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City | SLIDELL
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State | LA
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Zip | 70458-8160
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Country | US
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Telephone | 985-214-4330
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Fax | 985-214-4853
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Provider Business Mailing Address
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Address Line | 769 ROBERT BLVD # 1007
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City | SLIDELL
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State | LA
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Zip | 70458-1637
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Country | US
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Telephone | 985-214-4330
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Fax | 985-214-4853
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | RYSN BURRAS
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Credential |
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Telephone | 985-214-4330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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