NPI Code Detail JSON Logo

1679706261 NPI number — EAGLE APPLIED SCIENCES, LLC

NPI Number: 1679706261
Health Care Provider/Practitioner: EAGLE APPLIED SCIENCES, LLC

Information about “1679706261” NPI (EAGLE APPLIED SCIENCES, LLC) exists in 1679706261 in HTML format HTML  |  1679706261 in plain Text format TXT  |  1679706261 in PDF (Portable Document Format) PDF  |  1679706261 in an XML format XML  formats.

NPI Number : 1679706261 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679706261",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "EAGLE APPLIED SCIENCES, LLC",
    "ParentOrgTIN": null,
    "OrgName": "EAGLE APPLIED SCIENCES, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "200 CONCORD PLAZA DR",
    "SecondLineMailingAddress": "SUITE 430",
    "MailingAddressCityName": "SAN ANTONIO",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78216-6943",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "210-477-9242",
    "MailingAddressFaxNumber": "210-581-8609",
    "FirstLinePracticeLocationAddress": "225 E SONTERRA BLVD",
    "SecondLinePracticeLocationAddress": "SUITE 201",
    "PracticeLocationAddressCityName": "SAN ANTONIO",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78258-3992",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "210-477-2799",
    "PracticeLocationAddressFaxNumber": "210-490-0017",
    "EnumerationDate": "08/28/2009",
    "LastUpdateDate": "08/28/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BANTA",
    "AuthorizedOfficialFirstName": "GUY",
    "AuthorizedOfficialMiddleName": "ROBERT",
    "AuthorizedOfficialTitle": "PRESIDENT AND CEO",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PHD, MPH",
    "AuthorizedOfficialTelephoneNumber": "210-477-9242",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "133V00000X",
          "TaxonomyName": "Registered Dietitian",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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