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1689026676 NPI number — KNEE COASTER, LLC

NPI Number: 1689026676
Health Care Provider/Practitioner: KNEE COASTER, LLC

Information about “1689026676” NPI (KNEE COASTER, LLC) exists in 1689026676 in HTML format HTML  |  1689026676 in plain Text format TXT  |  1689026676 in PDF (Portable Document Format) PDF  |  1689026676 in an XML format XML  formats.

NPI Number : 1689026676 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689026676",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "KNEE COASTER, 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": "835 E LAMAR BLVD",
    "SecondLineMailingAddress": "STE 388",
    "MailingAddressCityName": "ARLINGTON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76011",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "817-798-7817",
    "MailingAddressFaxNumber": "844-734-2233",
    "FirstLinePracticeLocationAddress": "1675 SOTOGRANDE BLVD",
    "SecondLinePracticeLocationAddress": "202",
    "PracticeLocationAddressCityName": "HURST",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76053",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "817-798-7817",
    "PracticeLocationAddressFaxNumber": "844-734-2233",
    "EnumerationDate": "07/01/2016",
    "LastUpdateDate": "07/07/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "COBB",
    "AuthorizedOfficialFirstName": "EMILY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "MISS",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "817-798-7817",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "332B00000X",
        "TaxonomyName": "Durable Medical Equipment & Medical Supplies",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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