1598913972 NPI number — ADVANTAGE MEDICAL INFUSION LLC

NPI Number: 1598913972
Health Care Provider/Practitioner: ADVANTAGE MEDICAL INFUSION LLC

NPI Number : 1598913972 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1598913972",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ADVANTAGE MEDICAL INFUSION 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": "5296 OLD HIGHWAY 11",
    "SecondLineMailingAddress": "SUITE4",
    "MailingAddressCityName": "HATTIESBURG",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "39402-8380",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "601-450-0294",
    "MailingAddressFaxNumber": "601-450-0295",
    "FirstLinePracticeLocationAddress": "5296 OLD HIGHWAY 11",
    "SecondLinePracticeLocationAddress": "SUITE 4",
    "PracticeLocationAddressCityName": "HATTIESBURG",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "39402-8380",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "601-450-0294",
    "PracticeLocationAddressFaxNumber": "601-450-0295",
    "EnumerationDate": "08/28/2008",
    "LastUpdateDate": "04/11/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PIERCE",
    "AuthorizedOfficialFirstName": "WILLIAM",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "601-408-1251",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "OSP.0006471",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "64001757A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "A9-0001509",
          "LicenseNumberStateCode": "DE",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "4365",
          "LicenseNumberStateCode": "IA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "P06464",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "22-44611",
          "LicenseNumberStateCode": "KS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "PH28211",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "PCN.0002783",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "MS1820",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "PHY.006947-NR",
          "LicenseNumberStateCode": "LA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "054.018796",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "36488MS",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "MO40001711",
          "LicenseNumberStateCode": "ME",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "NRP1545",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0003X",
          "TaxonomyName": "Community/Retail Pharmacy",
          "LicenseNumber": "1471",
          "LicenseNumberStateCode": "AK",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}