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1639978950 NPI number — ERAGON PRECISION HEALTH LLC

NPI Number: 1639978950
Health Care Provider/Practitioner: ERAGON PRECISION HEALTH LLC

Information about “1639978950” NPI (ERAGON PRECISION HEALTH LLC) exists in 1639978950 in HTML format HTML  |  1639978950 in plain Text format TXT  |  1639978950 in PDF (Portable Document Format) PDF  |  1639978950 in an XML format XML  formats.

NPI Number : 1639978950 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639978950",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ERAGON PRECISION HEALTH 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": "400 W CAPITOL AVENUE",
    "SecondLineMailingAddress": "STE 1700 PNB 2587",
    "MailingAddressCityName": "LITTLE ROCK",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72201-3438",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "479-448-5929",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2501 SHEFFIELD DRIVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PINE BLUFF",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "71603",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "479-448-5929",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/10/2025",
    "LastUpdateDate": "03/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RICE",
    "AuthorizedOfficialFirstName": "ROSIE",
    "AuthorizedOfficialMiddleName": "L.",
    "AuthorizedOfficialTitle": "ADMINISTRATOR",
    "AuthorizedOfficialNamePrefix": "MISS",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "501-786-1759",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QH0100X",
          "TaxonomyName": "Health Service Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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