1841605995 NPI number — CAPE FEAR VALLEY HEALTH SYSTEM SPECIALTY GROUP, LLC

NPI Number: 1841605995
Health Care Provider/Practitioner: CAPE FEAR VALLEY HEALTH SYSTEM SPECIALTY GROUP, LLC

NPI Number : 1841605995 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1841605995",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CAPE FEAR VALLEY HEALTH SYSTEM SPECIALTY GROUP, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1638 OWEN DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FAYETTEVILLE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28304-3424",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "910-615-6910",
    "MailingAddressFaxNumber": "910-615-5626",
    "FirstLinePracticeLocationAddress": "805 TILGHMAN DR STE C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DUNN",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28334-5883",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "910-230-7800",
    "PracticeLocationAddressFaxNumber": "910-615-5626",
    "EnumerationDate": "06/27/2014",
    "LastUpdateDate": "11/10/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "NAGOWSKI",
    "AuthorizedOfficialFirstName": "MICHAEL",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "910-615-4000",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QX0200X",
          "TaxonomyName": "Oncology Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QH0100X",
          "TaxonomyName": "Health Service Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}