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1366037319 NPI number — WEST TEXAS PEDIATRIC SUBSPECIALTY GROUP

NPI Number: 1366037319
Health Care Provider/Practitioner: WEST TEXAS PEDIATRIC SUBSPECIALTY GROUP

Information about “1366037319” NPI (WEST TEXAS PEDIATRIC SUBSPECIALTY GROUP) exists in 1366037319 in HTML format HTML  |  1366037319 in plain Text format TXT  |  1366037319 in PDF (Portable Document Format) PDF  |  1366037319 in an XML format XML  formats.

NPI Number : 1366037319 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366037319",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WEST TEXAS PEDIATRIC SUBSPECIALTY GROUP",
    "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": "2533 ROGERS AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT WORTH",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76109-1348",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "817-228-3947",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "500 W 4TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ODESSA",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "79761-5001",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "432-640-1790",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/02/2021",
    "LastUpdateDate": "03/02/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LEVY",
    "AuthorizedOfficialFirstName": "VICTOR",
    "AuthorizedOfficialMiddleName": "YORK",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "817-228-3947",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208000000X",
          "TaxonomyName": "Pediatrics Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2080N0001X",
          "TaxonomyName": "Neonatal-Perinatal Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2080P0202X",
          "TaxonomyName": "Pediatric Cardiology 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."
        },
        {
          "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."
        },
        {
          "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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