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1598149403 NPI number — JANESVILLE PSYCHIATRIC CLINIC OF MAIN

NPI Number: 1598149403
Health Care Provider/Practitioner: JANESVILLE PSYCHIATRIC CLINIC OF MAIN

Information about “1598149403” NPI (JANESVILLE PSYCHIATRIC CLINIC OF MAIN) exists in 1598149403 in HTML format HTML  |  1598149403 in plain Text format TXT  |  1598149403 in PDF (Portable Document Format) PDF  |  1598149403 in an XML format XML  formats.

NPI Number : 1598149403 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1598149403",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "JANESVILLE PSYCHIATRIC CLINIC",
    "ParentOrgTIN": null,
    "OrgName": "JANESVILLE PSYCHIATRIC CLINIC OF MAIN",
    "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": "2010 PARKSIDE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JANESVILLE",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53548-6613",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "608-436-6161",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2010 PARKSIDE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JANESVILLE",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53548-6613",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "608-436-6161",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/10/2015",
    "LastUpdateDate": "07/20/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HOLLINGSWORTH",
    "AuthorizedOfficialFirstName": "WILLIAM",
    "AuthorizedOfficialMiddleName": "LEE",
    "AuthorizedOfficialTitle": "DIRECTOR",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MS",
    "AuthorizedOfficialTelephoneNumber": "608-436-6161",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": "162 - 124, 366 - 125",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": "3044- 123",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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