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1356214258 NPI number — MACKINSON PHILEUS

NPI Number: 1356214258
Health Care Provider/Practitioner: MACKINSON PHILEUS

Information about “1356214258” NPI (MACKINSON PHILEUS) exists in 1356214258 in HTML format HTML  |  1356214258 in plain Text format TXT  |  1356214258 in PDF (Portable Document Format) PDF  |  1356214258 in an XML format XML  formats.

NPI Number : 1356214258 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1356214258",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PHILEUS",
    "FirstName": "MACKINSON",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MAC",
    "OtherFirstName": "BIG",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "3947 ISLAND CLUB CIR W",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKE WORTH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33462-2183",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "561-895-3780",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "714 BARNETT DR BAY 23",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAKE WORTH BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33461-3357",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "561-895-3780",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/26/2025",
    "LastUpdateDate": "10/24/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "171W00000X",
        "TaxonomyName": "Contractor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X 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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