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1912385261 NPI number — THE UNIVERSITY OF SOUTH ALABAMA FAMILY PRACTICE

NPI Number: 1912385261
Health Care Provider/Practitioner: THE UNIVERSITY OF SOUTH ALABAMA FAMILY PRACTICE

Information about “1912385261” NPI (THE UNIVERSITY OF SOUTH ALABAMA FAMILY PRACTICE) exists in 1912385261 in HTML format HTML  |  1912385261 in plain Text format TXT  |  1912385261 in PDF (Portable Document Format) PDF  |  1912385261 in an XML format XML  formats.

NPI Number : 1912385261 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912385261",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "THE UNIVERSITY OF SOUTH ALABAMA FAMILY PRACTICE",
    "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": "3804 CABANA SQ",
    "SecondLineMailingAddress": "204",
    "MailingAddressCityName": "MOBILE",
    "MailingAddressStateName": "AL",
    "MailingAddressPostalCode": "36609-7610",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "205-523-1208",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1504 SPRING HILL AVE",
    "SecondLinePracticeLocationAddress": "1800",
    "PracticeLocationAddressCityName": "MOBILE",
    "PracticeLocationAddressStateName": "AL",
    "PracticeLocationAddressPostalCode": "36604-3207",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "251-434-3661",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/07/2015",
    "LastUpdateDate": "05/07/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MACMILLAN",
    "AuthorizedOfficialFirstName": "RENETTA",
    "AuthorizedOfficialMiddleName": "DENISE",
    "AuthorizedOfficialTitle": "MANAGER CLINICAL OPERATION",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "RN",
    "AuthorizedOfficialTelephoneNumber": "251-434-3661",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QF0400X",
        "TaxonomyName": "Federally Qualified Health Center (FQHC)",
        "LicenseNumber": "2530",
        "LicenseNumberStateCode": "AL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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