NPI Code Detail JSON Logo

1760905541 NPI number — PAIN MATTERS WELLNESS CENTER LLC

NPI Number: 1760905541
Health Care Provider/Practitioner: PAIN MATTERS WELLNESS CENTER LLC

Information about “1760905541” NPI (PAIN MATTERS WELLNESS CENTER LLC) exists in 1760905541 in HTML format HTML  |  1760905541 in plain Text format TXT  |  1760905541 in PDF (Portable Document Format) PDF  |  1760905541 in an XML format XML  formats.

NPI Number : 1760905541 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760905541",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PAIN MATTERS WELLNESS CENTER 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": "8235 CANYON TREE CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89113-4508",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "702-600-7391",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5235 S DURANGO DR STE 2",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAS VEGAS",
    "PracticeLocationAddressStateName": "NV",
    "PracticeLocationAddressPostalCode": "89113-0197",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "702-600-7391",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/24/2017",
    "LastUpdateDate": "07/24/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ERNST",
    "AuthorizedOfficialFirstName": "MARK",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PHYSICIAN ASSISTANT/OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PA",
    "AuthorizedOfficialTelephoneNumber": "702-600-7391",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "PA1736",
        "LicenseNumberStateCode": "NV",
        "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."
      }
    }
  }
}
                
            

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