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1083134209 NPI number — WISE DIAGNOSTIC SYSTEMS, LLC

NPI Number: 1083134209
Health Care Provider/Practitioner: WISE DIAGNOSTIC SYSTEMS, LLC

Information about “1083134209” NPI (WISE DIAGNOSTIC SYSTEMS, LLC) exists in 1083134209 in HTML format HTML  |  1083134209 in plain Text format TXT  |  1083134209 in PDF (Portable Document Format) PDF  |  1083134209 in an XML format XML  formats.

NPI Number : 1083134209 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083134209",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WISE DIAGNOSTIC SYSTEMS, 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": "1776 WOODSTEAD CT STE 107",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "THE WOODLANDS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77380-1450",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "855-947-3391",
    "MailingAddressFaxNumber": "855-947-3391",
    "FirstLinePracticeLocationAddress": "1776 WOODSTEAD CT STE 107",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "THE WOODLANDS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77380-1450",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "281-292-7411",
    "PracticeLocationAddressFaxNumber": "281-292-7481",
    "EnumerationDate": "06/20/2017",
    "LastUpdateDate": "09/27/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BRADY",
    "AuthorizedOfficialFirstName": "SCOTT",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "409-351-4756",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "291U00000X",
        "TaxonomyName": "Clinical Medical Laboratory",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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