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1629843958 NPI number — PIVOT SHIELD

NPI Number: 1629843958
Health Care Provider/Practitioner: PIVOT SHIELD

Information about “1629843958” NPI (PIVOT SHIELD) exists in 1629843958 in HTML format HTML  |  1629843958 in plain Text format TXT  |  1629843958 in PDF (Portable Document Format) PDF  |  1629843958 in an XML format XML  formats.

NPI Number : 1629843958 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629843958",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PIVOT SHIELD",
    "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": "20635 BEESTON GLADE LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KATY",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77449-2877",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "630-687-3084",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "20635 BEESTON GLADE LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KATY",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77449-2877",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "630-687-3084",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/16/2023",
    "LastUpdateDate": "11/28/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ODUOLA",
    "AuthorizedOfficialFirstName": "BANJI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "630-687-3084",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "343900000X",
          "TaxonomyName": "Non-emergency Medical Transport (VAN)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "343800000X",
          "TaxonomyName": "Secured Medical Transport (VAN)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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