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1558603555 NPI number — WELLSPACE HEALTH

NPI Number: 1558603555
Health Care Provider/Practitioner: WELLSPACE HEALTH

Information about “1558603555” NPI (WELLSPACE HEALTH) exists in 1558603555 in HTML format HTML  |  1558603555 in plain Text format TXT  |  1558603555 in PDF (Portable Document Format) PDF  |  1558603555 in an XML format XML  formats.

NPI Number : 1558603555 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558603555",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WELLSPACE HEALTH",
    "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": "1820 J ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SACRAMENTO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95811-3010",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "916-550-5481",
    "MailingAddressFaxNumber": "916-822-8974",
    "FirstLinePracticeLocationAddress": "3737 MARCONI AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SACRAMENTO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95821-5303",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "916-569-8660",
    "PracticeLocationAddressFaxNumber": "916-978-0310",
    "EnumerationDate": "03/18/2013",
    "LastUpdateDate": "08/16/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PORTEUS",
    "AuthorizedOfficialFirstName": "ALASDAIR",
    "AuthorizedOfficialMiddleName": "JONATHAN",
    "AuthorizedOfficialTitle": "CHIEF EXECUTIVE OFFICER",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PHD",
    "AuthorizedOfficialTelephoneNumber": "916-550-5444",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QF0400X",
        "TaxonomyName": "Federally Qualified Health Center (FQHC)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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