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1588173454 NPI number — THE OVAL CIRCLE LLC

NPI Number: 1588173454
Health Care Provider/Practitioner: THE OVAL CIRCLE LLC

Information about “1588173454” NPI (THE OVAL CIRCLE LLC) exists in 1588173454 in HTML format HTML  |  1588173454 in plain Text format TXT  |  1588173454 in PDF (Portable Document Format) PDF  |  1588173454 in an XML format XML  formats.

NPI Number : 1588173454 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1588173454",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "THE OVAL CIRCLE 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": "1408 ENGLISH OAK DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHAMPAIGN",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "61822-3351",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "217-766-5170",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "411 N CLARENDON CT STE 104",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAVOY",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "61874",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "815-683-6109",
    "PracticeLocationAddressFaxNumber": "888-665-3016",
    "EnumerationDate": "09/23/2017",
    "LastUpdateDate": "10/24/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BHOSALE",
    "AuthorizedOfficialFirstName": "NITIN",
    "AuthorizedOfficialMiddleName": "P",
    "AuthorizedOfficialTitle": "FOUNDER & CMO",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "815-683-6109",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0850X",
        "TaxonomyName": "Adult Mental Health Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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