NPI Code Detail JSON Logo

1386107019 NPI number — KEN SEELEY MEDICAL GROUP

NPI Number: 1386107019
Health Care Provider/Practitioner: KEN SEELEY MEDICAL GROUP

Information about “1386107019” NPI (KEN SEELEY MEDICAL GROUP) exists in 1386107019 in HTML format HTML  |  1386107019 in plain Text format TXT  |  1386107019 in PDF (Portable Document Format) PDF  |  1386107019 in an XML format XML  formats.

NPI Number : 1386107019 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1386107019",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "KEN SEELEY MEDICAL 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": "3076 ARROYO SECO",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PALM SPRINGS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92264-9686",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "323-401-3660",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "420 S PALM CANYON DR FL 2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PALM SPRINGS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92262-7304",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "323-401-3660",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/10/2019",
    "LastUpdateDate": "06/11/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MCLAUGHLIN",
    "AuthorizedOfficialFirstName": "ERIC",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "ASW",
    "AuthorizedOfficialTelephoneNumber": "323-401-3660",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251B00000X",
        "TaxonomyName": "Case Management Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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