NPI Code Detail JSON Logo

1053883595 NPI number — MOOSE CREEK MEDICAL CLINIC LLC

NPI Number: 1053883595
Health Care Provider/Practitioner: MOOSE CREEK MEDICAL CLINIC LLC

Information about “1053883595” NPI (MOOSE CREEK MEDICAL CLINIC LLC) exists in 1053883595 in HTML format HTML  |  1053883595 in plain Text format TXT  |  1053883595 in PDF (Portable Document Format) PDF  |  1053883595 in an XML format XML  formats.

NPI Number : 1053883595 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053883595",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MOOSE CREEK MEDICAL CLINIC LLC",
    "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": "2341 S. FERN ST., SUITE 300",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WASILLA",
    "MailingAddressStateName": "AK",
    "MailingAddressPostalCode": "99654",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "907-373-3335",
    "MailingAddressFaxNumber": "907-373-3331",
    "FirstLinePracticeLocationAddress": "2341 S. FERN ST., SUITE 300",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WASILLA",
    "PracticeLocationAddressStateName": "AK",
    "PracticeLocationAddressPostalCode": "99654",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "907-373-3335",
    "PracticeLocationAddressFaxNumber": "907-373-3331",
    "EnumerationDate": "12/21/2018",
    "LastUpdateDate": "12/21/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BROCK",
    "AuthorizedOfficialFirstName": "KIMBERLI",
    "AuthorizedOfficialMiddleName": "RAYE",
    "AuthorizedOfficialTitle": "ADVANCED NURSE PRACTITIONER, BUSINE",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "ANP",
    "AuthorizedOfficialTelephoneNumber": "907-373-3335",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LW0102X",
          "TaxonomyName": "Women's Health Nurse Practitioner",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LA2200X",
          "TaxonomyName": "Adult Health Nurse Practitioner",
          "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."
        },
        {
          "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."
        },
        {
          "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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