NPI Code Detail JSON Logo

1922532431 NPI number — INCREDIBLE MEDICAL SUPPLY

NPI Number: 1922532431
Health Care Provider/Practitioner: INCREDIBLE MEDICAL SUPPLY

Information about “1922532431” NPI (INCREDIBLE MEDICAL SUPPLY) exists in 1922532431 in HTML format HTML  |  1922532431 in plain Text format TXT  |  1922532431 in PDF (Portable Document Format) PDF  |  1922532431 in an XML format XML  formats.

NPI Number : 1922532431 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922532431",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "INCREDIBLE MEDICAL SUPPLY",
    "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": "3466 PROGRESS DR",
    "SecondLineMailingAddress": "SUITE 113",
    "MailingAddressCityName": "BENSALEM",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19020-5814",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "215-245-4555",
    "MailingAddressFaxNumber": "215-245-4552",
    "FirstLinePracticeLocationAddress": "3466 PROGRESS DR",
    "SecondLinePracticeLocationAddress": "SUITE 113",
    "PracticeLocationAddressCityName": "BENSALEM",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "19020-5814",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "215-245-4555",
    "PracticeLocationAddressFaxNumber": "215-245-4552",
    "EnumerationDate": "04/12/2017",
    "LastUpdateDate": "04/12/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DRAZEK",
    "AuthorizedOfficialFirstName": "GARY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "215-245-4555",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "332BP3500X",
          "TaxonomyName": "Parenteral & Enteral Nutrition Supplies (DME)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "332B00000X",
          "TaxonomyName": "Durable Medical Equipment & Medical Supplies",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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