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1053646190 NPI number — MORE CONVENIENT CARE CENTER LLC

NPI Number: 1053646190
Health Care Provider/Practitioner: MORE CONVENIENT CARE CENTER LLC

Information about “1053646190” NPI (MORE CONVENIENT CARE CENTER LLC) exists in 1053646190 in HTML format HTML  |  1053646190 in plain Text format TXT  |  1053646190 in PDF (Portable Document Format) PDF  |  1053646190 in an XML format XML  formats.

NPI Number : 1053646190 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053646190",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "MORE CONVENIENT CARE CENTER LLC",
    "ParentOrgTIN": null,
    "OrgName": "MORE CONVENIENT CARE CENTER LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "P. O. BOX 68483",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSON",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "39286",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "601-321-9104",
    "MailingAddressFaxNumber": "601-321-9138",
    "FirstLinePracticeLocationAddress": "4612 MEDGAR EVERS BLVD",
    "SecondLinePracticeLocationAddress": "SUITE 10",
    "PracticeLocationAddressCityName": "JACKSON",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "39213-5205",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "601-321-9104",
    "PracticeLocationAddressFaxNumber": "601-321-9138",
    "EnumerationDate": "10/07/2009",
    "LastUpdateDate": "11/18/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HILLIARD",
    "AuthorizedOfficialFirstName": "MARY",
    "AuthorizedOfficialMiddleName": "LYNN",
    "AuthorizedOfficialTitle": "FAMILY NURSE PRACTITIONER",
    "AuthorizedOfficialNamePrefix": "MS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "APRN, BC, FNP",
    "AuthorizedOfficialTelephoneNumber": "601-209-8432",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QP2300X",
        "TaxonomyName": "Primary Care Clinic/Center",
        "LicenseNumber": "R656046",
        "LicenseNumberStateCode": "MS",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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