NPI Code Detail JSON Logo

1407668908 NPI number — PATRIOTMED OF NORTH CAROLINA

NPI Number: 1407668908
Health Care Provider/Practitioner: PATRIOTMED OF NORTH CAROLINA

Information about “1407668908” NPI (PATRIOTMED OF NORTH CAROLINA) exists in 1407668908 in HTML format HTML  |  1407668908 in plain Text format TXT  |  1407668908 in PDF (Portable Document Format) PDF  |  1407668908 in an XML format XML  formats.

NPI Number : 1407668908 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407668908",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PATRIOTMED OF NORTH CAROLINA",
    "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": "22601 N 19TH AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PHOENIX",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85027-1326",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "480-369-1270",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2350 BENTRIDGE LN STE 400",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAYETTEVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28304-0590",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "480-369-1270",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/22/2025",
    "LastUpdateDate": "05/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "THORNOCK",
    "AuthorizedOfficialFirstName": "ROBERT",
    "AuthorizedOfficialMiddleName": "SCOTT",
    "AuthorizedOfficialTitle": "CHIEF STRATEGY OFFICER",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "480-369-1270",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "247100000X",
          "TaxonomyName": "Radiologic Technologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2085R0202X",
          "TaxonomyName": "Diagnostic Radiology 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."
        },
        {
          "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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