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1841571718 NPI number — ST JOSEPH CLINIC, P.C.

NPI Number: 1841571718
Health Care Provider/Practitioner: ST JOSEPH CLINIC, P.C.

Information about “1841571718” NPI (ST JOSEPH CLINIC, P.C.) exists in 1841571718 in HTML format HTML  |  1841571718 in plain Text format TXT  |  1841571718 in PDF (Portable Document Format) PDF  |  1841571718 in an XML format XML  formats.

NPI Number : 1841571718 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1841571718",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ST JOSEPH CLINIC, P.C.",
    "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": "1102 W WAUGH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DALTON",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30720-8769",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "706-277-2321",
    "MailingAddressFaxNumber": "706-428-2812",
    "FirstLinePracticeLocationAddress": "1720 GUNBARREL RD",
    "SecondLinePracticeLocationAddress": "SUITE 108",
    "PracticeLocationAddressCityName": "CHATTANOOGA",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37421-4144",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "706-277-2321",
    "PracticeLocationAddressFaxNumber": "706-428-2812",
    "EnumerationDate": "09/06/2011",
    "LastUpdateDate": "09/06/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PEREZ",
    "AuthorizedOfficialFirstName": "PABLO",
    "AuthorizedOfficialMiddleName": "E",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "706-277-2321",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "1993",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "MD0000045277",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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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