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General NPI Number Information
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NPI Number | 1740594605
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Entity Type | Organization
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Legal Business Name | INTENSIVE CARE INC
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 3517 W OWEN K GARRIOTT RD STE 5
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City | ENID
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State | OK
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Zip | 73703-4953
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Country | US
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Telephone | 800-579-5935
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Fax |
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Provider Business Mailing Address
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Address Line | 4012 S RAINBOW BLVD STE K320
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City | LAS VEGAS
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State | NV
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Zip | 89103-2010
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Country | US
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Telephone | 800-579-5935
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID J CARLBOM
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Credential | M.D.
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Telephone | 800-579-5935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 37D0472525
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License Number State | OK
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