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1780287342 NPI number — BEAR VALLEY MEDICAL CLINIC

NPI Number: 1780287342
Health Care Provider/Practitioner: BEAR VALLEY MEDICAL CLINIC

Information about “1780287342” NPI (BEAR VALLEY MEDICAL CLINIC) exists in 1780287342 in HTML format HTML  |  1780287342 in plain Text format TXT  |  1780287342 in PDF (Portable Document Format) PDF  |  1780287342 in an XML format XML  formats.

NPI Number : 1780287342 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780287342",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BEAR VALLEY MEDICAL CLINIC",
    "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": "1833 NEBRASKA AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GRANTS PASS",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97527-5701",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "541-226-9840",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1833 NEBRASKA AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GRANTS PASS",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97527-5701",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "541-226-9840",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/17/2020",
    "LastUpdateDate": "12/15/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "TIBBITS",
    "AuthorizedOfficialFirstName": "CHERIE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CLINIC MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "541-821-3522",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363L00000X",
        "TaxonomyName": "Nurse Practitioner",
        "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."
      }
    }
  }
}
                
            

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