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1497244909 NPI number — RADIX WELLNESS, LLC

NPI Number: 1497244909
Health Care Provider/Practitioner: RADIX WELLNESS, LLC

Information about “1497244909” NPI (RADIX WELLNESS, LLC) exists in 1497244909 in HTML format HTML  |  1497244909 in plain Text format TXT  |  1497244909 in PDF (Portable Document Format) PDF  |  1497244909 in an XML format XML  formats.

NPI Number : 1497244909 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497244909",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "RADIX WELLNESS, LLC",
    "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": "4716 W COMMERCE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HERNANDO",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "38632-8436",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "901-828-8019",
    "MailingAddressFaxNumber": "662-449-0598",
    "FirstLinePracticeLocationAddress": "1314 PEABODY AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MEMPHIS",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "38104-3500",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "901-828-8019",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/09/2018",
    "LastUpdateDate": "05/09/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PADGETT",
    "AuthorizedOfficialFirstName": "MELISSA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PARTNER",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "CPM",
    "AuthorizedOfficialTelephoneNumber": "901-828-8019",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM2500X",
        "TaxonomyName": "Medical Specialty Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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