NPI Code Detail JSON Logo

1679123632 NPI number — EQUILYST LLC.

NPI Number: 1679123632
Health Care Provider/Practitioner: EQUILYST LLC.

Information about “1679123632” NPI (EQUILYST LLC.) exists in 1679123632 in HTML format HTML  |  1679123632 in plain Text format TXT  |  1679123632 in PDF (Portable Document Format) PDF  |  1679123632 in an XML format XML  formats.

NPI Number : 1679123632 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679123632",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "EQUILYST 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": "3131 MAIN ST APT 122",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DALLAS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75226-1530",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "337-580-0710",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2909 CANTON ST STE C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DALLAS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75226-3508",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "214-984-3696",
    "PracticeLocationAddressFaxNumber": "469-523-5503",
    "EnumerationDate": "09/12/2019",
    "LastUpdateDate": "09/12/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "YORK",
    "AuthorizedOfficialFirstName": "WILLIAM",
    "AuthorizedOfficialMiddleName": "BLAKE",
    "AuthorizedOfficialTitle": "MANAGING MEMBER",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "FNP-C",
    "AuthorizedOfficialTelephoneNumber": "337-580-0710",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261Q00000X",
        "TaxonomyName": "Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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