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1689583601 NPI number — RESURGEONCE, LLC BDA COMPASS HUMAN PERFORMANCE

NPI Number: 1689583601
Health Care Provider/Practitioner: RESURGEONCE, LLC BDA COMPASS HUMAN PERFORMANCE

Information about “1689583601” NPI (RESURGEONCE, LLC BDA COMPASS HUMAN PERFORMANCE) exists in 1689583601 in HTML format HTML  |  1689583601 in plain Text format TXT  |  1689583601 in PDF (Portable Document Format) PDF  |  1689583601 in an XML format XML  formats.

NPI Number : 1689583601 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689583601",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "RESURGEONCE, LLC BDA COMPASS HUMAN PERFORMANCE",
    "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": "188 FRONT ST STE 116-30",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FRANKLIN",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37064-5078",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "931-212-5058",
    "MailingAddressFaxNumber": "615-526-6476",
    "FirstLinePracticeLocationAddress": "4525 HARDING PIKE STE 104",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NASHVILLE",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37205-6100",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "615-307-7246",
    "PracticeLocationAddressFaxNumber": "615-526-6476",
    "EnumerationDate": "09/04/2026",
    "LastUpdateDate": "09/04/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HOWARD",
    "AuthorizedOfficialFirstName": "JERRY",
    "AuthorizedOfficialMiddleName": "LEE",
    "AuthorizedOfficialTitle": "OWNER/ MEDICAL DIRECTOR",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": "II",
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "931-212-9106",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QP2300X",
        "TaxonomyName": "Primary Care Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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