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1720023484 NPI number — SPALDING TRIANGLE SURGERY CENTER, LLC

NPI Number: 1720023484
Health Care Provider/Practitioner: SPALDING TRIANGLE SURGERY CENTER, LLC

Information about “1720023484” NPI (SPALDING TRIANGLE SURGERY CENTER, LLC) exists in 1720023484 in HTML format HTML  |  1720023484 in plain Text format TXT  |  1720023484 in PDF (Portable Document Format) PDF  |  1720023484 in an XML format XML  formats.

NPI Number : 1720023484 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720023484",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SPALDING TRIANGLE SURGERY CENTER, LLC",
    "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": "120 S SPALDING DR STE 115",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BEVERLY HILLS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90212-1800",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "424-542-8485",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "120 S SPALDING DR STE 115",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BEVERLY HILLS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90212-1800",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "424-542-8485",
    "PracticeLocationAddressFaxNumber": "424-542-8487",
    "EnumerationDate": "06/18/2006",
    "LastUpdateDate": "05/07/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ODELL",
    "AuthorizedOfficialFirstName": "DAVID",
    "AuthorizedOfficialMiddleName": "W",
    "AuthorizedOfficialTitle": "MANAGING MEMBER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "805-679-7560",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QA1903X",
        "TaxonomyName": "Ambulatory Surgical Clinic/Center",
        "LicenseNumber": "550000124",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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