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General NPI Number Information
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NPI Number | 1659191054
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Entity Type | Organization
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Legal Business Name | WELLSPRING HEALTHCARE LLC
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 12700 ANTIOCH RD
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City | SHAWNEE MISSION
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State | KS
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Zip | 66213-2827
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Country | US
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Telephone | 909-815-3324
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Fax |
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Provider Business Mailing Address
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Address Line | 705B SE MELODY LN # 184
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City | LEES SUMMIT
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State | MO
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Zip | 64063-4380
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Country | US
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Telephone | 909-815-3324
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BRIAN MOORE HAAS
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Credential | DO
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Telephone | 816-698-8158
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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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