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1053626168 NPI number — VITAE CLINIC INC

NPI Number: 1053626168
Health Care Provider/Practitioner: VITAE CLINIC INC

Information about “1053626168” NPI (VITAE CLINIC INC) exists in 1053626168 in HTML format HTML  |  1053626168 in plain Text format TXT  |  1053626168 in PDF (Portable Document Format) PDF  |  1053626168 in an XML format XML  formats.

NPI Number : 1053626168 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053626168",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "VITAE CLINIC INC",
    "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": "PO BOX 301990",
    "SecondLineMailingAddress": "3507 N. LAMAR",
    "MailingAddressCityName": "AUSTIN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78703-0034",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "512-458-6060",
    "MailingAddressFaxNumber": "512-458-6070",
    "FirstLinePracticeLocationAddress": "1600 W 38TH ST",
    "SecondLinePracticeLocationAddress": "SUITE 115",
    "PracticeLocationAddressCityName": "AUSTIN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78731-6400",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "512-458-6060",
    "PracticeLocationAddressFaxNumber": "512-458-6070",
    "EnumerationDate": "08/12/2010",
    "LastUpdateDate": "01/05/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KALAMARIDES",
    "AuthorizedOfficialFirstName": "JEREMY",
    "AuthorizedOfficialMiddleName": "ANDREW",
    "AuthorizedOfficialTitle": "PHYSICIAN/MEDICAL DIRECTOR",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DO",
    "AuthorizedOfficialTelephoneNumber": "512-458-6060",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207V00000X",
        "TaxonomyName": "Obstetrics & Gynecology Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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