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General NPI Number Information
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NPI Number | 1659018018
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Entity Type | Organization
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Legal Business Name | OMNIA CARE PHYSICIAN SERVICES LLC
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Dates
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Enumeration Date | 05/17/2022
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 350 FALCON RIDGE PKWY STE 101
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City | MESQUITE
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State | NV
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Zip | 89027-8879
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Country | US
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Telephone | 702-849-0585
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Fax | 702-849-0614
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Provider Business Mailing Address
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Address Line | 350 FALCON RIDGE PKWY STE 101
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City | MESQUITE
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State | NV
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Zip | 89027-8879
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Country | US
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Telephone | 702-849-0585
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Fax | 702-849-0614
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Authorized Official
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Title or Position | MEMBER
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Name | WILLIAM S HOKANSON
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Credential |
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Telephone | 435-229-8882
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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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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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