NPI Code Detail JSON Logo

1326712100 NPI number — REVIVE SPA HYDRATION PLLC

NPI Number: 1326712100
Health Care Provider/Practitioner: REVIVE SPA HYDRATION PLLC

Information about “1326712100” NPI (REVIVE SPA HYDRATION PLLC) exists in 1326712100 in HTML format HTML  |  1326712100 in plain Text format TXT  |  1326712100 in PDF (Portable Document Format) PDF  |  1326712100 in an XML format XML  formats.

NPI Number : 1326712100 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1326712100",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "SECURE ALLIANCE PS LLC",
    "ParentOrgTIN": null,
    "OrgName": "REVIVE SPA HYDRATION PLLC",
    "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": "17609 29TH AVENUE CT E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TACOMA",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98445-4622",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "253-257-8340",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "17609 29TH AVENUE CT E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TACOMA",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98445-4622",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "253-257-8340",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/04/2021",
    "LastUpdateDate": "08/06/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SCHUBERT",
    "AuthorizedOfficialFirstName": "BETH",
    "AuthorizedOfficialMiddleName": "ANN",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RN",
    "AuthorizedOfficialTelephoneNumber": "253-257-8340",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163WI0500X",
          "TaxonomyName": "Infusion Therapy Registered Nurse",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WN1003X",
          "TaxonomyName": "Nutrition Support Registered Nurse",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261Q00000X",
          "TaxonomyName": "Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QI0500X",
          "TaxonomyName": "Infusion Therapy Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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