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1114259520 NPI number — BLUEBONNET MEDICAL CARE PA

NPI Number: 1114259520
Health Care Provider/Practitioner: BLUEBONNET MEDICAL CARE PA

Information about “1114259520” NPI (BLUEBONNET MEDICAL CARE PA) exists in 1114259520 in HTML format HTML  |  1114259520 in plain Text format TXT  |  1114259520 in PDF (Portable Document Format) PDF  |  1114259520 in an XML format XML  formats.

NPI Number : 1114259520 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114259520",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BLUEBONNET MEDICAL CARE PA",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2200 PHYSICIANS BLVD",
    "SecondLineMailingAddress": "SUITE I",
    "MailingAddressCityName": "ENNIS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75119-6247",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "972-875-9755",
    "MailingAddressFaxNumber": "972-905-9175",
    "FirstLinePracticeLocationAddress": "2200 PHYSICIANS BLVD",
    "SecondLinePracticeLocationAddress": "SUITE I",
    "PracticeLocationAddressCityName": "ENNIS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75119-6247",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "972-875-9755",
    "PracticeLocationAddressFaxNumber": "972-905-9175",
    "EnumerationDate": "02/10/2010",
    "LastUpdateDate": "07/12/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CROSBY",
    "AuthorizedOfficialFirstName": "BART",
    "AuthorizedOfficialMiddleName": "W",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DO",
    "AuthorizedOfficialTelephoneNumber": "972-875-9755",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QU0200X",
        "TaxonomyName": "Urgent Care Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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