NPI Code Detail JSON Logo

1619559812 NPI number — EVERGREEN MEDICAL CENTER, LLC

NPI Number: 1619559812
Health Care Provider/Practitioner: EVERGREEN MEDICAL CENTER, LLC

Information about “1619559812” NPI (EVERGREEN MEDICAL CENTER, LLC) exists in 1619559812 in HTML format HTML  |  1619559812 in plain Text format TXT  |  1619559812 in PDF (Portable Document Format) PDF  |  1619559812 in an XML format XML  formats.

NPI Number : 1619559812 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619559812",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "EVERGREEN MEDICAL CENTER, 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": "PO BOX 706",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EVERGREEN",
    "MailingAddressStateName": "AL",
    "MailingAddressPostalCode": "36401-0706",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "251-578-2480",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "225 PATTERSON AVE # A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GEORGIANA",
    "PracticeLocationAddressStateName": "AL",
    "PracticeLocationAddressPostalCode": "36033-6628",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "251-578-2480",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/27/2021",
    "LastUpdateDate": "04/27/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DUNN",
    "AuthorizedOfficialFirstName": "MELISSA",
    "AuthorizedOfficialMiddleName": "DIANE",
    "AuthorizedOfficialTitle": "CHIEF OPERATIONS OFFICER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "251-578-2480",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QR1300X",
        "TaxonomyName": "Rural Health Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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