NPI Code Detail JSON Logo

1760200216 NPI number — SKYLINE MEDICAL PLLC

NPI Number: 1760200216
Health Care Provider/Practitioner: SKYLINE MEDICAL PLLC

Information about “1760200216” NPI (SKYLINE MEDICAL PLLC) exists in 1760200216 in HTML format HTML  |  1760200216 in plain Text format TXT  |  1760200216 in PDF (Portable Document Format) PDF  |  1760200216 in an XML format XML  formats.

NPI Number : 1760200216 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760200216",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SKYLINE MEDICAL PLLC",
    "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": "200 BUTTERCUP CREEK BLVD STE 115",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CEDAR PARK",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78613-3701",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "512-777-1211",
    "MailingAddressFaxNumber": "512-777-1214",
    "FirstLinePracticeLocationAddress": "200 BUTTERCUP CREEK BLVD STE 115",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CEDAR PARK",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78613-3701",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "512-777-1211",
    "PracticeLocationAddressFaxNumber": "512-777-1214",
    "EnumerationDate": "10/02/2024",
    "LastUpdateDate": "12/09/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KIM",
    "AuthorizedOfficialFirstName": "DAVID",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "512-777-1211",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207LP2900X",
          "TaxonomyName": "Pain Medicine (Anesthesiology) Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208VP0000X",
          "TaxonomyName": "Pain Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208VP0014X",
          "TaxonomyName": "Interventional Pain 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."
        },
        {
          "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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