NPI Code Detail JSON Logo

1962779645 NPI number — THE FATIGUE CLINIC LLC

NPI Number: 1962779645
Health Care Provider/Practitioner: THE FATIGUE CLINIC LLC

Information about “1962779645” NPI (THE FATIGUE CLINIC LLC) exists in 1962779645 in HTML format HTML  |  1962779645 in plain Text format TXT  |  1962779645 in PDF (Portable Document Format) PDF  |  1962779645 in an XML format XML  formats.

NPI Number : 1962779645 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962779645",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "THE FATIGUE CLINIC 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": "890 W POPLAR AVE STE 6",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLLIERVILLE",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "38017-2582",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "901-221-8621",
    "MailingAddressFaxNumber": "901-221-8631",
    "FirstLinePracticeLocationAddress": "890 W POPLAR AVE STE 6",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLLIERVILLE",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "38017-2582",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "901-221-8621",
    "PracticeLocationAddressFaxNumber": "901-221-8631",
    "EnumerationDate": "11/22/2011",
    "LastUpdateDate": "08/13/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "EARL",
    "AuthorizedOfficialFirstName": "SUSAN",
    "AuthorizedOfficialMiddleName": "D",
    "AuthorizedOfficialTitle": "OWNER/PROVIDER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "ACNP",
    "AuthorizedOfficialTelephoneNumber": "901-221-8621",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261Q00000X",
        "TaxonomyName": "Clinic/Center",
        "LicenseNumber": "12687",
        "LicenseNumberStateCode": "TN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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