NPI Code Detail JSON Logo

1669184305 NPI number — SMART LAB DX, LLC

NPI Number: 1669184305
Health Care Provider/Practitioner: SMART LAB DX, LLC

Information about “1669184305” NPI (SMART LAB DX, LLC) exists in 1669184305 in HTML format HTML  |  1669184305 in plain Text format TXT  |  1669184305 in PDF (Portable Document Format) PDF  |  1669184305 in an XML format XML  formats.

NPI Number : 1669184305 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669184305",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SMART LAB DX, 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": "3500 N STATE ROAD 7 STE 102",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAUDERDALE LAKES",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33319-5616",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-694-1777",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3500 N STATE ROAD 7 STE 102",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAUDERDALE LAKES",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33319-5616",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-694-1777",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/14/2022",
    "LastUpdateDate": "02/06/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MARTINEZ",
    "AuthorizedOfficialFirstName": "TSEHIA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "LAB DIRECTOR",
    "AuthorizedOfficialNamePrefix": "MS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "954-400-8125",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251F00000X",
          "TaxonomyName": "Home Infusion Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "291U00000X",
          "TaxonomyName": "Clinical Medical Laboratory",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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