NPI Code Detail JSON Logo

1417545088 NPI number — NEXUS SPINE INSTITUTE, LLC

NPI Number: 1417545088
Health Care Provider/Practitioner: NEXUS SPINE INSTITUTE, LLC

Information about “1417545088” NPI (NEXUS SPINE INSTITUTE, LLC) exists in 1417545088 in HTML format HTML  |  1417545088 in plain Text format TXT  |  1417545088 in PDF (Portable Document Format) PDF  |  1417545088 in an XML format XML  formats.

NPI Number : 1417545088 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417545088",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "NEXUS SPINE INSTITUTE, LLC",
    "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": "107 N 11TH ST # 508",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TAMPA",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33602-4242",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "813-358-3578",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10676 BLOOMINGDALE AVE STE 3",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RIVERVIEW",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33578-4292",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "813-358-3578",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/08/2021",
    "LastUpdateDate": "01/08/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "TRAVIS",
    "AuthorizedOfficialFirstName": "HEATHER",
    "AuthorizedOfficialMiddleName": "M",
    "AuthorizedOfficialTitle": "CHIEF OPERATING OFFICER",
    "AuthorizedOfficialNamePrefix": "MISS",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "813-358-3578",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "111NX0800X",
          "TaxonomyName": "Orthopedic Chiropractor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207X00000X",
          "TaxonomyName": "Orthopaedic Surgery Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208VP0014X",
          "TaxonomyName": "Interventional Pain Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207XS0117X",
          "TaxonomyName": "Orthopaedic Surgery of the Spine 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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