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1790455343 NPI number — CENTRAL ATHLETE

NPI Number: 1790455343
Health Care Provider/Practitioner: CENTRAL ATHLETE

Information about “1790455343” NPI (CENTRAL ATHLETE) exists in 1790455343 in HTML format HTML  |  1790455343 in plain Text format TXT  |  1790455343 in PDF (Portable Document Format) PDF  |  1790455343 in an XML format XML  formats.

NPI Number : 1790455343 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790455343",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CENTRAL ATHLETE",
    "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": "1023 SPRINGDALE RD BLDG 9B",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AUSTIN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78721-2442",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "512-672-6760",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1023 SPRINGDALE RD BLDG 9B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AUSTIN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78721-2442",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "512-672-6760",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/15/2021",
    "LastUpdateDate": "09/15/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "OBRIEN",
    "AuthorizedOfficialFirstName": "JESSE",
    "AuthorizedOfficialMiddleName": "ALEXANDER",
    "AuthorizedOfficialTitle": "FOUNDER AND HEAD COACH",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "512-680-7783",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QH0100X",
        "TaxonomyName": "Health Service Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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