1437280534 NPI number — WEST TEXAS COUNSELLING AND REHABILITATION PROGRAM OF SAN ANGELO, INC.

NPI Number: 1437280534
Health Care Provider/Practitioner: WEST TEXAS COUNSELLING AND REHABILITATION PROGRAM OF SAN ANGELO, INC.

NPI Number : 1437280534 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1437280534",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WEST TEXAS COUNSELLING AND REHABILITATION PROGRAM OF SAN ANGELO, INC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 303249",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AUSTIN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78703-0055",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "601 S IRVING ST STE D",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN ANGELO",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76903-6961",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "325-653-3683",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/08/2007",
    "LastUpdateDate": "04/29/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GARCIA",
    "AuthorizedOfficialFirstName": "IVAN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "325-653-3683",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QM2800X",
          "TaxonomyName": "Methadone Clinic",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QR0405X",
          "TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}