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1811601537 NPI number — BODY POTIONS EMPORIUM, INC.

NPI Number: 1811601537
Health Care Provider/Practitioner: BODY POTIONS EMPORIUM, INC.

Information about “1811601537” NPI (BODY POTIONS EMPORIUM, INC.) exists in 1811601537 in HTML format HTML  |  1811601537 in plain Text format TXT  |  1811601537 in PDF (Portable Document Format) PDF  |  1811601537 in an XML format XML  formats.

NPI Number : 1811601537 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811601537",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BODY POTIONS EMPORIUM, INC.",
    "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": "3620 WYOMING BLVD NE STE 110",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALBUQUERQUE",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "87111-3286",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "505-910-4410",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3620 WYOMING BLVD NE STE 110",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ALBUQUERQUE",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "87111-3286",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "505-910-4410",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/09/2023",
    "LastUpdateDate": "01/09/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ATREIDES",
    "AuthorizedOfficialFirstName": "JAVIN",
    "AuthorizedOfficialMiddleName": "LAEBEIN",
    "AuthorizedOfficialTitle": "FOUNDER CEO AND MASSAGE THERAPIST",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LMT 8032",
    "AuthorizedOfficialTelephoneNumber": "505-688-1377",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QH0100X",
          "TaxonomyName": "Health Service Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "332800000X",
          "TaxonomyName": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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