NPI Code Detail JSON Logo

1154357291 NPI number — ASSOCIATED ORAL AND MAXILLOFACIAL SURGEONS OF PEORIA, LTD

NPI Number: 1154357291
Health Care Provider/Practitioner: ASSOCIATED ORAL AND MAXILLOFACIAL SURGEONS OF PEORIA, LTD

Information about “1154357291” NPI (ASSOCIATED ORAL AND MAXILLOFACIAL SURGEONS OF PEORIA, LTD) exists in 1154357291 in HTML format HTML  |  1154357291 in plain Text format TXT  |  1154357291 in PDF (Portable Document Format) PDF  |  1154357291 in an XML format XML  formats.

NPI Number : 1154357291 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154357291",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ASSOCIATED ORAL AND MAXILLOFACIAL SURGEONS OF PEORIA, LTD",
    "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": "5720 N KNOXVILLE AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PEORIA",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "61614-4331",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "309-682-1213",
    "MailingAddressFaxNumber": "309-682-5386",
    "FirstLinePracticeLocationAddress": "5720 N KNOXVILLE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PEORIA",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "61614-4331",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "309-682-1213",
    "PracticeLocationAddressFaxNumber": "309-682-5386",
    "EnumerationDate": "06/23/2006",
    "LastUpdateDate": "11/05/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WOLFE",
    "AuthorizedOfficialFirstName": "ROBYN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRACTICE LEADER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "309-682-1249",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1223S0112X",
          "TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
          "LicenseNumber": "019023700",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223S0112X",
          "TaxonomyName": "Oral and Maxillofacial Surgery (Dentist)",
          "LicenseNumber": "019024407",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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