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General NPI Number Information
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NPI Number | 1801693866
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Entity Type | Organization
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Legal Business Name | ILLUMIA HEALTH LLC
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 1718 INDIAN WOOD CIR STE A1
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City | MAUMEE
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State | OH
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Zip | 43537-4090
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Country | US
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Telephone | 704-664-2876
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Fax | 704-664-1306
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Provider Business Mailing Address
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Address Line | PO BOX 4060 ATTN: REGULATORY
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City | MOORESVILLE
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State | NC
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Zip | 28117-4060
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Country | US
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Telephone | 704-664-2876
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Fax |
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Authorized Official
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Title or Position | VP OF LICENSURE
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Name | JANET L. COMBS
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Credential |
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Telephone | 704-662-1761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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