NPI Code Detail JSON Logo

1760223390 NPI number — 804 MED LLC

NPI Number: 1760223390
Health Care Provider/Practitioner: 804 MED LLC

Information about “1760223390” NPI (804 MED LLC) exists in 1760223390 in HTML format HTML  |  1760223390 in plain Text format TXT  |  1760223390 in PDF (Portable Document Format) PDF  |  1760223390 in an XML format XML  formats.

NPI Number : 1760223390 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760223390",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "804 MED 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": "425 N ARTHUR ASHE BLVD APT 2",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RICHMOND",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23220-3306",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "804-517-6853",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "515 RAY C HUNT DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHARLOTTESVILLE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22903-2981",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "434-244-2000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/06/2024",
    "LastUpdateDate": "06/06/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "THOMPSON",
    "AuthorizedOfficialFirstName": "MATTHEW",
    "AuthorizedOfficialMiddleName": "H",
    "AuthorizedOfficialTitle": "PRESIDENT/OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "804-517-6853",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207R00000X",
        "TaxonomyName": "Internal Medicine Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.