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1487229761 NPI number — PROVISIONS HEALTH SERVICES

NPI Number: 1487229761
Health Care Provider/Practitioner: PROVISIONS HEALTH SERVICES

Information about “1487229761” NPI (PROVISIONS HEALTH SERVICES) exists in 1487229761 in HTML format HTML  |  1487229761 in plain Text format TXT  |  1487229761 in PDF (Portable Document Format) PDF  |  1487229761 in an XML format XML  formats.

NPI Number : 1487229761 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1487229761",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PROVISIONS HEALTH SERVICES",
    "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": "2522 GOLF RD STE 2",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EAU CLAIRE",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54701-6033",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "715-833-0660",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2522 GOLF RD STE 2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EAU CLAIRE",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54701-6033",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "715-833-0660",
    "PracticeLocationAddressFaxNumber": "715-833-0669",
    "EnumerationDate": "05/20/2021",
    "LastUpdateDate": "02/12/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SCHROM",
    "AuthorizedOfficialFirstName": "DANIELLE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "REGIONAL MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "715-833-0660",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261Q00000X",
        "TaxonomyName": "Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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