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1104984111 NPI number — COAG THERAPEUTICS SOUTH INC.

NPI Number: 1104984111
Health Care Provider/Practitioner: COAG THERAPEUTICS SOUTH INC.

Information about “1104984111” NPI (COAG THERAPEUTICS SOUTH INC.) exists in 1104984111 in HTML format HTML  |  1104984111 in plain Text format TXT  |  1104984111 in PDF (Portable Document Format) PDF  |  1104984111 in an XML format XML  formats.

NPI Number : 1104984111 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104984111",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "COAG THERAPEUTICS SOUTH INC.",
    "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": "53 N JACKSON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MOBILE",
    "MailingAddressStateName": "AL",
    "MailingAddressPostalCode": "36602-2809",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "53 N JACKSON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MOBILE",
    "PracticeLocationAddressStateName": "AL",
    "PracticeLocationAddressPostalCode": "36602-2809",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "251-432-2525",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/04/2006",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MITCHELL",
    "AuthorizedOfficialFirstName": "JOHN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "251-432-2525",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "112884",
          "LicenseNumberStateCode": "AL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336H0001X",
          "TaxonomyName": "Home Infusion Therapy Pharmacy",
          "LicenseNumber": "112884",
          "LicenseNumberStateCode": "AL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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