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1780173971 NPI number — PREMIER MEDICAL DEVELOPMENT

NPI Number: 1780173971
Health Care Provider/Practitioner: PREMIER MEDICAL DEVELOPMENT

Information about “1780173971” NPI (PREMIER MEDICAL DEVELOPMENT) exists in 1780173971 in HTML format HTML  |  1780173971 in plain Text format TXT  |  1780173971 in PDF (Portable Document Format) PDF  |  1780173971 in an XML format XML  formats.

NPI Number : 1780173971 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780173971",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PREMIER MEDICAL DEVELOPMENT",
    "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": "29155 NORTHWESTERN HWY STE 428",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTHFIELD",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48034-1011",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "29155 NORTHWESTERN HWY STE 428",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTHFIELD",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48034-1011",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "877-220-8411",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/03/2018",
    "LastUpdateDate": "11/16/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "JALLOUQA",
    "AuthorizedOfficialFirstName": "ANZOUR",
    "AuthorizedOfficialMiddleName": "S",
    "AuthorizedOfficialTitle": "PRACTICE MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "877-220-8411",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "332B00000X",
          "TaxonomyName": "Durable Medical Equipment & Medical Supplies",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336C0002X",
          "TaxonomyName": "Clinic Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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