NPI Code Detail JSON Logo

1295558484 NPI number — NORTHSTAR MEDICAL GROUP LLC

NPI Number: 1295558484
Health Care Provider/Practitioner: NORTHSTAR MEDICAL GROUP LLC

Information about “1295558484” NPI (NORTHSTAR MEDICAL GROUP LLC) exists in 1295558484 in HTML format HTML  |  1295558484 in plain Text format TXT  |  1295558484 in PDF (Portable Document Format) PDF  |  1295558484 in an XML format XML  formats.

NPI Number : 1295558484 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295558484",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "NORTHSTAR MEDICAL GROUP 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": "351 DOVER RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CLARKSVILLE",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37042-4144",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "931-552-4495",
    "MailingAddressFaxNumber": "931-552-0121",
    "FirstLinePracticeLocationAddress": "351 DOVER RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CLARKSVILLE",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37042-4144",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "931-552-4495",
    "PracticeLocationAddressFaxNumber": "931-552-0121",
    "EnumerationDate": "11/05/2024",
    "LastUpdateDate": "11/19/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CARNEY",
    "AuthorizedOfficialFirstName": "WILLIAM",
    "AuthorizedOfficialMiddleName": "R",
    "AuthorizedOfficialTitle": "CHIEF PHYSICIAN",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": "JR.",
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "615-891-0202",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QP2300X",
        "TaxonomyName": "Primary Care Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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