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1023455953 NPI number — EASTERN SHORE DEVELOPMENTAL CLINIC

NPI Number: 1023455953
Health Care Provider/Practitioner: EASTERN SHORE DEVELOPMENTAL CLINIC

Information about “1023455953” NPI (EASTERN SHORE DEVELOPMENTAL CLINIC) exists in 1023455953 in HTML format HTML  |  1023455953 in plain Text format TXT  |  1023455953 in PDF (Portable Document Format) PDF  |  1023455953 in an XML format XML  formats.

NPI Number : 1023455953 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1023455953",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "EASTERN SHORE DEVELOPMENTAL CLINIC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "26420 KENSINGTON PL STE A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DAPHNE",
    "MailingAddressStateName": "AL",
    "MailingAddressPostalCode": "36526-5123",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "251-625-0400",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "26420 KENSINGTON PL STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DAPHNE",
    "PracticeLocationAddressStateName": "AL",
    "PracticeLocationAddressPostalCode": "36526-5123",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "251-625-0400",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/02/2013",
    "LastUpdateDate": "06/02/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WIGGINS",
    "AuthorizedOfficialFirstName": "WARNER",
    "AuthorizedOfficialMiddleName": "MERRILL",
    "AuthorizedOfficialTitle": "OFFICAL",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "251-402-5589",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208000000X",
          "TaxonomyName": "Pediatrics Physician",
          "LicenseNumber": "00008950",
          "LicenseNumberStateCode": "AL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "1076812",
          "LicenseNumberStateCode": "AL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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