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1053791061 NPI number — BRIDGE BREAST CENTER

NPI Number: 1053791061
Health Care Provider/Practitioner: BRIDGE BREAST CENTER

Information about “1053791061” NPI (BRIDGE BREAST CENTER) exists in 1053791061 in HTML format HTML  |  1053791061 in plain Text format TXT  |  1053791061 in PDF (Portable Document Format) PDF  |  1053791061 in an XML format XML  formats.

NPI Number : 1053791061 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053791061",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BRIDGE BREAST CENTER",
    "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": "4000 JUNIUS ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DALLAS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75246-1622",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "214-821-3820",
    "MailingAddressFaxNumber": "214-821-0869",
    "FirstLinePracticeLocationAddress": "4000 JUNIUS ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DALLAS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75246-1622",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "214-821-3820",
    "PracticeLocationAddressFaxNumber": "214-821-0869",
    "EnumerationDate": "06/04/2015",
    "LastUpdateDate": "06/04/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WILSON-GRAY",
    "AuthorizedOfficialFirstName": "TERRY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
    "AuthorizedOfficialNamePrefix": "MS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MPA",
    "AuthorizedOfficialTelephoneNumber": "214-821-3820",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251B00000X",
        "TaxonomyName": "Case Management Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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