NPI Code Detail JSON Logo

1215667936 NPI number — TRIFECTA FAMILY WELLNESS LLC

NPI Number: 1215667936
Health Care Provider/Practitioner: TRIFECTA FAMILY WELLNESS LLC

Information about “1215667936” NPI (TRIFECTA FAMILY WELLNESS LLC) exists in 1215667936 in HTML format HTML  |  1215667936 in plain Text format TXT  |  1215667936 in PDF (Portable Document Format) PDF  |  1215667936 in an XML format XML  formats.

NPI Number : 1215667936 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215667936",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "TRIFECTA FAMILY WELLNESS LLC",
    "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": "805 EAGLERIDGE BLVD STE 150",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PUEBLO",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "81008-2194",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "719-627-4287",
    "MailingAddressFaxNumber": "719-220-7658",
    "FirstLinePracticeLocationAddress": "805 EAGLERIDGE BLVD STE 150",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PUEBLO",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "81008-2194",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "719-627-4287",
    "PracticeLocationAddressFaxNumber": "719-220-7658",
    "EnumerationDate": "06/15/2022",
    "LastUpdateDate": "02/07/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "QUICK",
    "AuthorizedOfficialFirstName": "BRANDIE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "FNP-C",
    "AuthorizedOfficialTelephoneNumber": "719-468-1569",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207Q00000X",
        "TaxonomyName": "Family Medicine Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X 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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