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1174824643 NPI number — WOLVERINE STATE INPATIENT SERVICES, PLLC

NPI Number: 1174824643
Health Care Provider/Practitioner: WOLVERINE STATE INPATIENT SERVICES, PLLC

Information about “1174824643” NPI (WOLVERINE STATE INPATIENT SERVICES, PLLC) exists in 1174824643 in HTML format HTML  |  1174824643 in plain Text format TXT  |  1174824643 in PDF (Portable Document Format) PDF  |  1174824643 in an XML format XML  formats.

NPI Number : 1174824643 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174824643",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WOLVERINE STATE INPATIENT SERVICES, PLLC",
    "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": "815 S PALAFOX ST",
    "SecondLineMailingAddress": "300",
    "MailingAddressCityName": "PENSACOLA",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32502-5960",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "800-444-7009",
    "MailingAddressFaxNumber": "800-305-3233",
    "FirstLinePracticeLocationAddress": "703 N MCEWAN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CLARE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48617-1440",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "214-712-2472",
    "PracticeLocationAddressFaxNumber": "214-712-2444",
    "EnumerationDate": "11/15/2010",
    "LastUpdateDate": "07/05/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WEBSTER",
    "AuthorizedOfficialFirstName": "DOUGLAS",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DO",
    "AuthorizedOfficialTelephoneNumber": "214-712-2000",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208M00000X",
        "TaxonomyName": "Hospitalist 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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