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1467997239 NPI number — LITTLE RIVER BAND OF OTTAWA INDIANS

NPI Number: 1467997239
Health Care Provider/Practitioner: LITTLE RIVER BAND OF OTTAWA INDIANS

Information about “1467997239” NPI (LITTLE RIVER BAND OF OTTAWA INDIANS) exists in 1467997239 in HTML format HTML  |  1467997239 in plain Text format TXT  |  1467997239 in PDF (Portable Document Format) PDF  |  1467997239 in an XML format XML  formats.

NPI Number : 1467997239 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467997239",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "LITTLE RIVER BAND OF OTTAWA INDIANS",
    "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": "2608 GOVERNMENT CENTER DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MANISTEE",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49660-8302",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "231-398-6853",
    "MailingAddressFaxNumber": "231-723-1523",
    "FirstLinePracticeLocationAddress": "2608 GOVERNMENT CENTER DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MANISTEE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49660-8302",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "231-398-6853",
    "PracticeLocationAddressFaxNumber": "231-723-1523",
    "EnumerationDate": "01/03/2017",
    "LastUpdateDate": "12/04/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "JACQUE",
    "AuthorizedOfficialFirstName": "KEITH",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CHIEF PHARMACIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "231-398-6853",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "3336C0002X",
          "TaxonomyName": "Clinic Pharmacy",
          "LicenseNumber": "5301011115",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "5301011115",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "332800000X",
          "TaxonomyName": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
          "LicenseNumber": "5301011115",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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