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1295561801 NPI number — COMPASSIONATE PSYCHIATRIC SERVICES OF SOUTHLAKE PA

NPI Number: 1295561801
Health Care Provider/Practitioner: COMPASSIONATE PSYCHIATRIC SERVICES OF SOUTHLAKE PA

Information about “1295561801” NPI (COMPASSIONATE PSYCHIATRIC SERVICES OF SOUTHLAKE PA) exists in 1295561801 in HTML format HTML  |  1295561801 in plain Text format TXT  |  1295561801 in PDF (Portable Document Format) PDF  |  1295561801 in an XML format XML  formats.

NPI Number : 1295561801 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295561801",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "COMPASSIONATE PSYCHIATRIC SERVICES OF SOUTHLAKE 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": "281 W SOUTHLAKE BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTHLAKE",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76092-7052",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "469-200-4093",
    "MailingAddressFaxNumber": "469-200-4079",
    "FirstLinePracticeLocationAddress": "281 W SOUTHLAKE BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTHLAKE",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76092-7052",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "469-200-4093",
    "PracticeLocationAddressFaxNumber": "469-200-4079",
    "EnumerationDate": "09/10/2024",
    "LastUpdateDate": "11/18/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MOHAMMED",
    "AuthorizedOfficialFirstName": "NAZIMUDDIN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "217-750-3053",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2084N0400X",
        "TaxonomyName": "Neurology 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."
      }
    }
  }
}
                
            

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