NPI Code Detail JSON Logo

1275257917 NPI number — ZKALA IC - MYRTLE

NPI Number: 1275257917
Health Care Provider/Practitioner: ZKALA IC - MYRTLE

Information about “1275257917” NPI (ZKALA IC - MYRTLE) exists in 1275257917 in HTML format HTML  |  1275257917 in plain Text format TXT  |  1275257917 in PDF (Portable Document Format) PDF  |  1275257917 in an XML format XML  formats.

NPI Number : 1275257917 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275257917",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "Z'KALA, LLC",
    "ParentOrgTIN": null,
    "OrgName": "ZKALA IC - MYRTLE",
    "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": "8050 N 19TH AVE STE 500",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PHOENIX",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85021-5160",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "623-842-9000",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7112 N 55TH AVE STE C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GLENDALE",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85301-0707",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "602-842-9000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/27/2022",
    "LastUpdateDate": "09/27/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LEE",
    "AuthorizedOfficialFirstName": "JAVAN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "EXECUTIVE LEADERSHIP",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "623-777-8339",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251B00000X",
          "TaxonomyName": "Case Management Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QD0000X",
          "TaxonomyName": "Dental Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0850X",
          "TaxonomyName": "Adult Mental Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM1300X",
          "TaxonomyName": "Multi-Specialty Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "332800000X",
          "TaxonomyName": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "343900000X",
          "TaxonomyName": "Non-emergency Medical Transport (VAN)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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