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1285873240 NPI number — PLATTE VALLEY PAIN CARE PC

NPI Number: 1285873240
Health Care Provider/Practitioner: PLATTE VALLEY PAIN CARE PC

Information about “1285873240” NPI (PLATTE VALLEY PAIN CARE PC) exists in 1285873240 in HTML format HTML  |  1285873240 in plain Text format TXT  |  1285873240 in PDF (Portable Document Format) PDF  |  1285873240 in an XML format XML  formats.

NPI Number : 1285873240 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285873240",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PLATTE VALLEY PAIN CARE PC",
    "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": "PO BOX 310255",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DES MOINES",
    "MailingAddressStateName": "IA",
    "MailingAddressPostalCode": "50331-0255",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "308-236-0507",
    "MailingAddressFaxNumber": "308-236-0509",
    "FirstLinePracticeLocationAddress": "2908 W 39TH ST",
    "SecondLinePracticeLocationAddress": "SUITE D",
    "PracticeLocationAddressCityName": "KEARNEY",
    "PracticeLocationAddressStateName": "NE",
    "PracticeLocationAddressPostalCode": "68845-1225",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "308-236-0507",
    "PracticeLocationAddressFaxNumber": "308-236-0509",
    "EnumerationDate": "02/16/2009",
    "LastUpdateDate": "11/24/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BALTER",
    "AuthorizedOfficialFirstName": "KEVIN",
    "AuthorizedOfficialMiddleName": "SCOTT",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "308-236-0507",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103TC1900X",
          "TaxonomyName": "Counseling Psychologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207LP2900X",
          "TaxonomyName": "Pain Medicine (Anesthesiology) 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."
        },
        {
          "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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