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1922641406 NPI number — REGENERATIVE MEDICINE OF SOUTH ALABAMA LLC

NPI Number: 1922641406
Health Care Provider/Practitioner: REGENERATIVE MEDICINE OF SOUTH ALABAMA LLC

Information about “1922641406” NPI (REGENERATIVE MEDICINE OF SOUTH ALABAMA LLC) exists in 1922641406 in HTML format HTML  |  1922641406 in plain Text format TXT  |  1922641406 in PDF (Portable Document Format) PDF  |  1922641406 in an XML format XML  formats.

NPI Number : 1922641406 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922641406",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "REGENERATIVE MEDICINE OF SOUTH ALABAMA LLC",
    "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": "3929 AIRPORT BLVD STE 3-110",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MOBILE",
    "MailingAddressStateName": "AL",
    "MailingAddressPostalCode": "36609-2234",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "251-307-1855",
    "MailingAddressFaxNumber": "251-301-0870",
    "FirstLinePracticeLocationAddress": "3929 AIRPORT BLVD STE 3-110",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MOBILE",
    "PracticeLocationAddressStateName": "AL",
    "PracticeLocationAddressPostalCode": "36609-2234",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "251-307-1855",
    "PracticeLocationAddressFaxNumber": "251-301-0870",
    "EnumerationDate": "10/28/2019",
    "LastUpdateDate": "10/07/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LOPEZ",
    "AuthorizedOfficialFirstName": "KYLE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DC",
    "AuthorizedOfficialTelephoneNumber": "251-490-3235",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QH0100X",
        "TaxonomyName": "Health Service Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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