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1801688619 NPI number — WATERTOWER PLAZA MEDICAL

NPI Number: 1801688619
Health Care Provider/Practitioner: WATERTOWER PLAZA MEDICAL

Information about “1801688619” NPI (WATERTOWER PLAZA MEDICAL) exists in 1801688619 in HTML format HTML  |  1801688619 in plain Text format TXT  |  1801688619 in PDF (Portable Document Format) PDF  |  1801688619 in an XML format XML  formats.

NPI Number : 1801688619 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1801688619",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WATERTOWER PLAZA MEDICAL",
    "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": "1610 MENTOR AVE STE 2",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PAINESVILLE",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "44077-1745",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "440-352-4321",
    "MailingAddressFaxNumber": "440-352-4321",
    "FirstLinePracticeLocationAddress": "25200 CHAGRIN BLVD STE 302",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BEACHWOOD",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "44122-5685",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "216-302-0947",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/19/2025",
    "LastUpdateDate": "05/19/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GROVES",
    "AuthorizedOfficialFirstName": "LINDA",
    "AuthorizedOfficialMiddleName": "L",
    "AuthorizedOfficialTitle": "BILLING AND CREDENTIALING MGR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "CPC COC MBP CMA",
    "AuthorizedOfficialTelephoneNumber": "440-352-4321",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208D00000X",
          "TaxonomyName": "General Practice Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "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."
        },
        {
          "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."
        },
        {
          "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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