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1215349667 NPI number — MIDSOUTH MEDICAL SPECIALTIES, LLC

NPI Number: 1215349667
Health Care Provider/Practitioner: MIDSOUTH MEDICAL SPECIALTIES, LLC

Information about “1215349667” NPI (MIDSOUTH MEDICAL SPECIALTIES, LLC) exists in 1215349667 in HTML format HTML  |  1215349667 in plain Text format TXT  |  1215349667 in PDF (Portable Document Format) PDF  |  1215349667 in an XML format XML  formats.

NPI Number : 1215349667 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215349667",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "MIDSOUTH MEDICAL SPECIALTIES, LLC",
    "ParentOrgTIN": null,
    "OrgName": "MIDSOUTH MEDICAL SPECIALTIES, LLC",
    "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": "PO BOX 563",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HERNANDO",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "38632-0563",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "501-463-9922",
    "MailingAddressFaxNumber": "501-463-9925",
    "FirstLinePracticeLocationAddress": "5500 CENTRAL AVENUE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOT SPRINGS",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "71913",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "14-639-9225",
    "PracticeLocationAddressFaxNumber": "501-463-9925",
    "EnumerationDate": "05/20/2014",
    "LastUpdateDate": "07/06/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "O'BANNON",
    "AuthorizedOfficialFirstName": "EDDIE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "901-262-4317",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "3336L0003X",
          "TaxonomyName": "Long Term Care Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0004X",
          "TaxonomyName": "Compounding Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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