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1992996821 NPI number — VARICOSE VEIN CENTER OF ST LOUIS, INC

NPI Number: 1992996821
Health Care Provider/Practitioner: VARICOSE VEIN CENTER OF ST LOUIS, INC

Information about “1992996821” NPI (VARICOSE VEIN CENTER OF ST LOUIS, INC) exists in 1992996821 in HTML format HTML  |  1992996821 in plain Text format TXT  |  1992996821 in PDF (Portable Document Format) PDF  |  1992996821 in an XML format XML  formats.

NPI Number : 1992996821 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992996821",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "VARICOSE VEIN CENTER OF ST LOUIS, INC",
    "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": "12360 MANCHESTER RD",
    "SecondLineMailingAddress": "STE 206",
    "MailingAddressCityName": "SAINT LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63131-4312",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-966-6100",
    "MailingAddressFaxNumber": "314-966-8148",
    "FirstLinePracticeLocationAddress": "12360 MANCHESTER RD",
    "SecondLinePracticeLocationAddress": "STE 206",
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63131-4312",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-966-6100",
    "PracticeLocationAddressFaxNumber": "314-966-8148",
    "EnumerationDate": "08/06/2007",
    "LastUpdateDate": "08/06/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BLUMENTHAL",
    "AuthorizedOfficialFirstName": "MARK",
    "AuthorizedOfficialMiddleName": "F",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "314-966-6100",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "174400000X",
        "TaxonomyName": "Specialist",
        "LicenseNumber": "R7718",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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