NPI Code Detail JSON Logo

1689052359 NPI number — COASTAL VEIN & VASCULAR INSTITUTE, LLC

NPI Number: 1689052359
Health Care Provider/Practitioner: COASTAL VEIN & VASCULAR INSTITUTE, LLC

Information about “1689052359” NPI (COASTAL VEIN & VASCULAR INSTITUTE, LLC) exists in 1689052359 in HTML format HTML  |  1689052359 in plain Text format TXT  |  1689052359 in PDF (Portable Document Format) PDF  |  1689052359 in an XML format XML  formats.

NPI Number : 1689052359 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689052359",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "DRS. MORI, BEAN & BROOKS, PA",
    "ParentOrgTIN": null,
    "OrgName": "COASTAL VEIN & VASCULAR INSTITUTE, 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": "3599 UNIVERSITY BLVD S",
    "SecondLineMailingAddress": "BLDG 300",
    "MailingAddressCityName": "JACKSONVILLE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32216-4252",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-399-5550",
    "MailingAddressFaxNumber": "904-346-4334",
    "FirstLinePracticeLocationAddress": "7741 POINT MEADOWS DR",
    "SecondLinePracticeLocationAddress": "UNIT 104-106",
    "PracticeLocationAddressCityName": "JACKSONVILLE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32256-9182",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-399-5550",
    "PracticeLocationAddressFaxNumber": "904-346-4334",
    "EnumerationDate": "05/13/2015",
    "LastUpdateDate": "02/16/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MORI",
    "AuthorizedOfficialFirstName": "KURT",
    "AuthorizedOfficialMiddleName": "W",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "904-399-5550",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2085R0202X",
          "TaxonomyName": "Diagnostic Radiology Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2085R0204X",
          "TaxonomyName": "Vascular & Interventional Radiology Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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