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1811467053 NPI number — MISSOURI OBESITY CENTER,LLC

NPI Number: 1811467053
Health Care Provider/Practitioner: MISSOURI OBESITY CENTER,LLC

Information about “1811467053” NPI (MISSOURI OBESITY CENTER,LLC) exists in 1811467053 in HTML format HTML  |  1811467053 in plain Text format TXT  |  1811467053 in PDF (Portable Document Format) PDF  |  1811467053 in an XML format XML  formats.

NPI Number : 1811467053 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811467053",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MISSOURI OBESITY 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": "5102 BEACON FALLS DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBIA",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "65203-9056",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "417-988-5306",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1601 E BROADWAY STE 160",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBIA",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "65201-5821",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "573-777-9917",
    "PracticeLocationAddressFaxNumber": "573-777-9918",
    "EnumerationDate": "11/30/2018",
    "LastUpdateDate": "11/30/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WIREDU",
    "AuthorizedOfficialFirstName": "CHARLES",
    "AuthorizedOfficialMiddleName": "KONTOR",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "417-988-5306",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207RE0101X",
        "TaxonomyName": "Endocrinology, Diabetes & Metabolism Physician",
        "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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