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1700937836 NPI number — ACTIVE BRACE AND LIMB LLC

NPI Number: 1700937836
Health Care Provider/Practitioner: ACTIVE BRACE AND LIMB LLC

Information about “1700937836” NPI (ACTIVE BRACE AND LIMB LLC) exists in 1700937836 in HTML format HTML  |  1700937836 in plain Text format TXT  |  1700937836 in PDF (Portable Document Format) PDF  |  1700937836 in an XML format XML  formats.

NPI Number : 1700937836 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700937836",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ACTIVE BRACE AND LIMB 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": "5123 N ROYAL DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TRAVERSE CITY",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49684-9201",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "231-932-8702",
    "MailingAddressFaxNumber": "231-932-8702",
    "FirstLinePracticeLocationAddress": "2780 CHARLEVOIX AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PETOSKEY",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49770-8058",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "231-487-0998",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/16/2007",
    "LastUpdateDate": "12/18/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PIERCE",
    "AuthorizedOfficialFirstName": "JERRY",
    "AuthorizedOfficialMiddleName": "ALLEN",
    "AuthorizedOfficialTitle": "CO OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "CO",
    "AuthorizedOfficialTelephoneNumber": "231-487-0998",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "332BC3200X",
          "TaxonomyName": "Customized Equipment (DME)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "332B00000X",
          "TaxonomyName": "Durable Medical Equipment & Medical Supplies",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "335E00000X",
          "TaxonomyName": "Prosthetic/Orthotic Supplier",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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