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General NPI Number Information
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NPI Number | 1962493700
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Entity Type | Organization
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Legal Business Name | INTEGRATED HEALTH CONCEPTS, INC.
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Dates
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Enumeration Date | 11/01/2005
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Last Update Date | 09/14/2023
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Provider Practice Location Address
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Address Line | 720 AEROVISTA PL SUITE D
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-8726
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Country | US
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Telephone | 866-239-3784
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Fax | 800-977-9255
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Provider Business Mailing Address
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Address Line | 720 AEROVISTA PL SUITE D
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-8726
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Country | US
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Telephone | 866-239-3784
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Fax | 800-977-9255
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Authorized Official
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Title or Position | CEO
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Name | TAYLOR CLINE
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Credential |
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Telephone | 940-395-6726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PHY 51610
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY46553
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License Number State | CA
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