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1700150869 NPI number — FAMILY MEDICINE RURAL HEALTH CLINIC, PA

NPI Number: 1700150869
Health Care Provider/Practitioner: FAMILY MEDICINE RURAL HEALTH CLINIC, PA

Information about “1700150869” NPI (FAMILY MEDICINE RURAL HEALTH CLINIC, PA) exists in 1700150869 in HTML format HTML  |  1700150869 in plain Text format TXT  |  1700150869 in PDF (Portable Document Format) PDF  |  1700150869 in an XML format XML  formats.

NPI Number : 1700150869 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700150869",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FAMILY MEDICINE RURAL HEALTH CLINIC, PA",
    "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": "207 W AVENUE E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAMPASAS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76550-1820",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "512-556-3621",
    "MailingAddressFaxNumber": "512-556-4080",
    "FirstLinePracticeLocationAddress": "2401 WALKER PLACE BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COPPERAS COVE",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76522-4025",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "254-547-5516",
    "PracticeLocationAddressFaxNumber": "254-542-0039",
    "EnumerationDate": "03/06/2012",
    "LastUpdateDate": "03/20/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LANE",
    "AuthorizedOfficialFirstName": "MARK",
    "AuthorizedOfficialMiddleName": "S",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "512-556-3621",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208000000X",
          "TaxonomyName": "Pediatrics Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QR1300X",
          "TaxonomyName": "Rural Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "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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