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1619760162 NPI number — DRUID CITY PHYSICIAN SERVICES, LLC

NPI Number: 1619760162
Health Care Provider/Practitioner: DRUID CITY PHYSICIAN SERVICES, LLC

Information about “1619760162” NPI (DRUID CITY PHYSICIAN SERVICES, LLC) exists in 1619760162 in HTML format HTML  |  1619760162 in plain Text format TXT  |  1619760162 in PDF (Portable Document Format) PDF  |  1619760162 in an XML format XML  formats.

NPI Number : 1619760162 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619760162",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DRUID CITY PHYSICIAN SERVICES, 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": "701 UNIVERSITY BLVD E STE 400",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TUSCALOOSA",
    "MailingAddressStateName": "AL",
    "MailingAddressPostalCode": "35401-7428",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "205-752-0694",
    "MailingAddressFaxNumber": "205-752-6244",
    "FirstLinePracticeLocationAddress": "701 UNIVERSITY BLVD E STE 400",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TUSCALOOSA",
    "PracticeLocationAddressStateName": "AL",
    "PracticeLocationAddressPostalCode": "35401-7428",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "205-752-0694",
    "PracticeLocationAddressFaxNumber": "205-752-6244",
    "EnumerationDate": "05/27/2025",
    "LastUpdateDate": "05/27/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CONVILLE",
    "AuthorizedOfficialFirstName": "DANIEL",
    "AuthorizedOfficialMiddleName": "CLAY",
    "AuthorizedOfficialTitle": "VICE PRESIDENT, PHYSICIAN SERVICES",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "205-759-6165",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207RI0011X",
        "TaxonomyName": "Interventional Cardiology Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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