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1326866872 NPI number — OPTIMIZE MEDICAL LAB

NPI Number: 1326866872
Health Care Provider/Practitioner: OPTIMIZE MEDICAL LAB

Information about “1326866872” NPI (OPTIMIZE MEDICAL LAB) exists in 1326866872 in HTML format HTML  |  1326866872 in plain Text format TXT  |  1326866872 in PDF (Portable Document Format) PDF  |  1326866872 in an XML format XML  formats.

NPI Number : 1326866872 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1326866872",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "OPTIMIZE MEDICAL LAB",
    "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": "1213 W MOREHEAD ST STE 253",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHARLOTTE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28208-5576",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "980-207-0638",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "322 LAMAR AVE STE 107",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHARLOTTE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28204-2436",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "802-070-6389",
    "PracticeLocationAddressFaxNumber": "980-276-3083",
    "EnumerationDate": "10/02/2024",
    "LastUpdateDate": "10/02/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "TOWNSEND",
    "AuthorizedOfficialFirstName": "CHARLOTTE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CLINICAL ADMINSTRATOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MA",
    "AuthorizedOfficialTelephoneNumber": "802-448-9909",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251J00000X",
          "TaxonomyName": "Nursing Care Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QH0100X",
          "TaxonomyName": "Health Service Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0801X",
          "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "291U00000X",
          "TaxonomyName": "Clinical Medical Laboratory",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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