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1275168650 NPI number — MEDWIN PA

NPI Number: 1275168650
Health Care Provider/Practitioner: MEDWIN PA

Information about “1275168650” NPI (MEDWIN PA) exists in 1275168650 in HTML format HTML  |  1275168650 in plain Text format TXT  |  1275168650 in PDF (Portable Document Format) PDF  |  1275168650 in an XML format XML  formats.

NPI Number : 1275168650 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275168650",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MEDWIN PA",
    "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 4067",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FT LAUDERDALE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33338-4067",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "786-214-2001",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4850 W OAKLAND PARK BLVD STE 224",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAUDERDALE LAKES",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33313-7261",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "786-214-2001",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/06/2020",
    "LastUpdateDate": "04/08/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "EDWIN",
    "AuthorizedOfficialFirstName": "MICAH",
    "AuthorizedOfficialMiddleName": "BOAZ",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "786-214-2001",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QP2300X",
        "TaxonomyName": "Primary Care Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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