NPI Code Detail JSON Logo

1053926154 NPI number — IDOC VIRTUAL NEURO CRITICAL CARE LLC

NPI Number: 1053926154
Health Care Provider/Practitioner: IDOC VIRTUAL NEURO CRITICAL CARE LLC

Information about “1053926154” NPI (IDOC VIRTUAL NEURO CRITICAL CARE LLC) exists in 1053926154 in HTML format HTML  |  1053926154 in plain Text format TXT  |  1053926154 in PDF (Portable Document Format) PDF  |  1053926154 in an XML format XML  formats.

NPI Number : 1053926154 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053926154",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "IDOC VIRTUAL NEURO CRITICAL CARE 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": "4635 SOUTHWEST FWY STE 525",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOUSTON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77027-7157",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "713-234-4431",
    "MailingAddressFaxNumber": "877-712-5707",
    "FirstLinePracticeLocationAddress": "1133 EAGLES LANDING PKWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STOCKBRIDGE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30281-5085",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "713-913-1422",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/15/2020",
    "LastUpdateDate": "08/21/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LEWIS",
    "AuthorizedOfficialFirstName": "EVETTE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRACTICE MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "503-421-5124",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207LC0200X",
          "TaxonomyName": "Critical Care Medicine (Anesthesiology) Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RC0200X",
          "TaxonomyName": "Critical Care Medicine (Internal Medicine) Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LC0200X",
          "TaxonomyName": "Critical Care Medicine Nurse Practitioner",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "174400000X",
          "TaxonomyName": "Specialist",
          "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."
        },
        {
          "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."
        }
      ]
    }
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.