NPI Code Detail JSON Logo

1528616992 NPI number — EAST TEXAS BORDER HEALTH CLINIC

NPI Number: 1528616992
Health Care Provider/Practitioner: EAST TEXAS BORDER HEALTH CLINIC

Information about “1528616992” NPI (EAST TEXAS BORDER HEALTH CLINIC) exists in 1528616992 in HTML format HTML  |  1528616992 in plain Text format TXT  |  1528616992 in PDF (Portable Document Format) PDF  |  1528616992 in an XML format XML  formats.

NPI Number : 1528616992 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1528616992",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "EAST TEXAS BORDER HEALTH CLINIC",
    "ParentOrgTIN": null,
    "OrgName": "EAST TEXAS BORDER HEALTH CLINIC",
    "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 1326",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MARSHALL",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75671-1326",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "903-927-1764",
    "MailingAddressFaxNumber": "903-927-1764",
    "FirstLinePracticeLocationAddress": "1400 COLLEGE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TEXARKANA",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75503-3536",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "903-792-8296",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/29/2019",
    "LastUpdateDate": "08/28/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ROADCAP",
    "AuthorizedOfficialFirstName": "CARLA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "903-927-3782",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "3336C0003X",
        "TaxonomyName": "Community/Retail Pharmacy",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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