1124303094 NPI number — N.E.X.T. LEVEL HEALTH CENTER, INC.

NPI Number: 1124303094
Health Care Provider/Practitioner: N.E.X.T. LEVEL HEALTH CENTER, INC.

NPI Number : 1124303094 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124303094",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "N.E.X.T. LEVEL HEALTH CENTER, 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": "2105 NIAGARA ST.",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "IDAHO FALLS",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83404",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-528-6010",
    "MailingAddressFaxNumber": "208-528-6011",
    "FirstLinePracticeLocationAddress": "2105 NIAGARA",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "IDAHO FALLS",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83404",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-528-6010",
    "PracticeLocationAddressFaxNumber": "208-528-6011",
    "EnumerationDate": "10/11/2011",
    "LastUpdateDate": "12/09/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HAMMON",
    "AuthorizedOfficialFirstName": "JUSTIN",
    "AuthorizedOfficialMiddleName": "TYRELL",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "D.C.",
    "AuthorizedOfficialTelephoneNumber": "208-528-6010",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QH0100X",
          "TaxonomyName": "Health Service Clinic/Center",
          "LicenseNumber": "ACT-251",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QH0100X",
          "TaxonomyName": "Health Service Clinic/Center",
          "LicenseNumber": "CHIA-1341",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}