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1952994204 NPI number — SAINT MARY MEDICAL

NPI Number: 1952994204
Health Care Provider/Practitioner: SAINT MARY MEDICAL

Information about “1952994204” NPI (SAINT MARY MEDICAL) exists in 1952994204 in HTML format HTML  |  1952994204 in plain Text format TXT  |  1952994204 in PDF (Portable Document Format) PDF  |  1952994204 in an XML format XML  formats.

NPI Number : 1952994204 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1952994204",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SAINT MARY MEDICAL",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1332 LEXINGTON SQ SW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VERO BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32962-3411",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "347-309-1829",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4651 BABCOCK ST NE STE 5A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PALM BAY",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32905-2808",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "347-309-1829",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/18/2021",
    "LastUpdateDate": "07/30/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BAKHET",
    "AuthorizedOfficialFirstName": "MARINA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "347-309-1829",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "3336C0003X",
        "TaxonomyName": "Community/Retail Pharmacy",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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