1861063307 NPI number — SAM FERRELL SCT(ASCP), MT(AMT)

NPI Number: 1861063307
Health Care Provider/Practitioner: SAM FERRELL SCT(ASCP), MT(AMT)

NPI Number : 1861063307 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861063307",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FERRELL",
    "FirstName": "SAM",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "SCT(ASCP), MT(AMT)",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "156 SCOTT CREEK WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BRENTWOOD",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94513-2460",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "925-503-9562",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4150 CLEMENT ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN FRANCISCO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94121-1563",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "415-221-4810",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/06/2021",
    "LastUpdateDate": "07/09/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "246QC2700X",
          "TaxonomyName": "Cytotechnology Specialist/Technologist",
          "LicenseNumber": "676",
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "291U00000X",
          "TaxonomyName": "Clinical Medical Laboratory",
          "LicenseNumber": "2736023",
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "246QC2700X",
          "TaxonomyName": "Cytotechnology Specialist/Technologist",
          "LicenseNumber": "02039975",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}