NPI Code Detail JSON Logo

1598164337 NPI number — TRICORNE PRIMARY NERVE & JOINT, LLC

NPI Number: 1598164337
Health Care Provider/Practitioner: TRICORNE PRIMARY NERVE & JOINT, LLC

Information about “1598164337” NPI (TRICORNE PRIMARY NERVE & JOINT, LLC) exists in 1598164337 in HTML format HTML  |  1598164337 in plain Text format TXT  |  1598164337 in PDF (Portable Document Format) PDF  |  1598164337 in an XML format XML  formats.

NPI Number : 1598164337 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1598164337",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "TRICORNE PRIMARY NERVE & JOINT, LLC",
    "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": "2200 S GEORGE ST",
    "SecondLineMailingAddress": "SUITE W-2",
    "MailingAddressCityName": "YORK",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "17403-4594",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "717-747-3220",
    "MailingAddressFaxNumber": "717-747-3338",
    "FirstLinePracticeLocationAddress": "2200 S GEORGE ST",
    "SecondLinePracticeLocationAddress": "SUITE W-2",
    "PracticeLocationAddressCityName": "YORK",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "17403-4594",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "717-747-3220",
    "PracticeLocationAddressFaxNumber": "717-747-3338",
    "EnumerationDate": "08/18/2014",
    "LastUpdateDate": "01/20/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "EDWARDS",
    "AuthorizedOfficialFirstName": "EARL",
    "AuthorizedOfficialMiddleName": "W",
    "AuthorizedOfficialTitle": "SOLE MEMBER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "717-747-3220",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QH0100X",
          "TaxonomyName": "Health Service Clinic/Center",
          "LicenseNumber": "MD427825",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM1300X",
          "TaxonomyName": "Multi-Specialty Clinic/Center",
          "LicenseNumber": "MD427825",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "302R00000X",
          "TaxonomyName": "Health Maintenance Organization",
          "LicenseNumber": "MD427825",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "305R00000X",
          "TaxonomyName": "Preferred Provider Organization",
          "LicenseNumber": "MD427825",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "305S00000X",
          "TaxonomyName": "Point of Service",
          "LicenseNumber": "MD427825",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QP3300X",
          "TaxonomyName": "Pain Clinic/Center",
          "LicenseNumber": "BE8901060",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QP2300X",
          "TaxonomyName": "Primary Care Clinic/Center",
          "LicenseNumber": "MD427825",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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