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1952590077 NPI number — FALL CREEK SURGICAL ASSISTANTS

NPI Number: 1952590077
Health Care Provider/Practitioner: FALL CREEK SURGICAL ASSISTANTS

Information about “1952590077” NPI (FALL CREEK SURGICAL ASSISTANTS) exists in 1952590077 in HTML format HTML  |  1952590077 in plain Text format TXT  |  1952590077 in PDF (Portable Document Format) PDF  |  1952590077 in an XML format XML  formats.

NPI Number : 1952590077 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1952590077",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FALL CREEK SURGICAL ASSISTANTS",
    "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": "PO BOX 820428",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NORTH RICHLAND HILLS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76182-0428",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "817-605-0991",
    "MailingAddressFaxNumber": "817-605-0993",
    "FirstLinePracticeLocationAddress": "1504 KELSEY DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KELLER",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76248-6878",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "817-605-0991",
    "PracticeLocationAddressFaxNumber": "817-605-0993",
    "EnumerationDate": "10/15/2007",
    "LastUpdateDate": "10/15/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MCCLEERY",
    "AuthorizedOfficialFirstName": "GREGORY",
    "AuthorizedOfficialMiddleName": "B",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LSA",
    "AuthorizedOfficialTelephoneNumber": "817-605-0991",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363AS0400X",
        "TaxonomyName": "Surgical Physician Assistant",
        "LicenseNumber": "SA00132",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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