NPI Code Detail JSON Logo

1104642214 NPI number — DIAMOND STATE VASCULAR INTERVENTIONAL LLC

NPI Number: 1104642214
Health Care Provider/Practitioner: DIAMOND STATE VASCULAR INTERVENTIONAL LLC

Information about “1104642214” NPI (DIAMOND STATE VASCULAR INTERVENTIONAL LLC) exists in 1104642214 in HTML format HTML  |  1104642214 in plain Text format TXT  |  1104642214 in PDF (Portable Document Format) PDF  |  1104642214 in an XML format XML  formats.

NPI Number : 1104642214 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104642214",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DIAMOND STATE VASCULAR INTERVENTIONAL 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": "9450 SW GEMINI DR STE 59742",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BEAVERTON",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97008-7105",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "571-265-9715",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1941 LIMESTONE RD STE 15",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WILMINGTON",
    "PracticeLocationAddressStateName": "DE",
    "PracticeLocationAddressPostalCode": "19808-5423",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "571-265-9715",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/25/2024",
    "LastUpdateDate": "11/25/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DASGUPTA",
    "AuthorizedOfficialFirstName": "NILOY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "STAFF",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "571-265-9715",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2085R0204X",
        "TaxonomyName": "Vascular & Interventional Radiology Physician",
        "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."
      }
    }
  }
}
                
            

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