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1689025389 NPI number — CENTRE PROFESSIONAL ASSOCIATES LLC

NPI Number: 1689025389
Health Care Provider/Practitioner: CENTRE PROFESSIONAL ASSOCIATES LLC

Information about “1689025389” NPI (CENTRE PROFESSIONAL ASSOCIATES LLC) exists in 1689025389 in HTML format HTML  |  1689025389 in plain Text format TXT  |  1689025389 in PDF (Portable Document Format) PDF  |  1689025389 in an XML format XML  formats.

NPI Number : 1689025389 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689025389",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CENTRE PROFESSIONAL ASSOCIATES 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": "PO BOX 1120",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LEMONT",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "16851-1120",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "814-689-9744",
    "MailingAddressFaxNumber": "888-981-8069",
    "FirstLinePracticeLocationAddress": "315 S ALLEN ST",
    "SecondLinePracticeLocationAddress": "STE 216",
    "PracticeLocationAddressCityName": "STATE COLLEGE",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "16801-4849",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "814-689-9744",
    "PracticeLocationAddressFaxNumber": "888-981-8069",
    "EnumerationDate": "06/24/2016",
    "LastUpdateDate": "06/24/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DERSTINE",
    "AuthorizedOfficialFirstName": "TIMOTHY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "814-689-9744",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2084A0401X",
          "TaxonomyName": "Addiction Medicine (Psychiatry & Neurology) Physician",
          "LicenseNumber": "MD056013L",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "MD056013L",
          "LicenseNumberStateCode": "PA",
          "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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