NPI Code Detail JSON Logo

1649113028 NPI number — ICONIC HEALTHCARE, LLC

NPI Number: 1649113028
Health Care Provider/Practitioner: ICONIC HEALTHCARE, LLC

Information about “1649113028” NPI (ICONIC HEALTHCARE, LLC) exists in 1649113028 in HTML format HTML  |  1649113028 in plain Text format TXT  |  1649113028 in PDF (Portable Document Format) PDF  |  1649113028 in an XML format XML  formats.

NPI Number : 1649113028 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649113028",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ICONIC HEALTHCARE, 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": "769 ROBERT BLVD # 1007",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SLIDELL",
    "MailingAddressStateName": "LA",
    "MailingAddressPostalCode": "70458-1637",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "985-214-4330",
    "MailingAddressFaxNumber": "985-214-4853",
    "FirstLinePracticeLocationAddress": "1810 LINDBERG DR STE 2400",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SLIDELL",
    "PracticeLocationAddressStateName": "LA",
    "PracticeLocationAddressPostalCode": "70458-8160",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "985-214-4330",
    "PracticeLocationAddressFaxNumber": "985-214-4853",
    "EnumerationDate": "04/10/2026",
    "LastUpdateDate": "04/10/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BURRAS",
    "AuthorizedOfficialFirstName": "RYSN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRACTICE MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "985-214-4330",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QP2300X",
        "TaxonomyName": "Primary Care Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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