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1023710332 NPI number — EAST TEXAS PREMIER PEDIATRICS PLLC

NPI Number: 1023710332
Health Care Provider/Practitioner: EAST TEXAS PREMIER PEDIATRICS PLLC

Information about “1023710332” NPI (EAST TEXAS PREMIER PEDIATRICS PLLC) exists in 1023710332 in HTML format HTML  |  1023710332 in plain Text format TXT  |  1023710332 in PDF (Portable Document Format) PDF  |  1023710332 in an XML format XML  formats.

NPI Number : 1023710332 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1023710332",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "EAST TEXAS PREMIER PEDIATRICS PLLC",
    "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": "210 AUTUMN LAKE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LUFKIN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75904-7489",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "214-729-6038",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1 MEDICAL CENTER BLVD STE B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LUFKIN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75904-3173",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "936-671-3428",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/20/2023",
    "LastUpdateDate": "03/20/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SWINK",
    "AuthorizedOfficialFirstName": "CHARLIA",
    "AuthorizedOfficialMiddleName": "DEVON",
    "AuthorizedOfficialTitle": "CREDENTIALING",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "214-729-6038",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208000000X",
        "TaxonomyName": "Pediatrics Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X 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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