NPI |
1558885137 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Last Name Legal Name |
BROOKS |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider First Name |
GARLAND |
The first name of the provider, if the provider
is an individual. |
Provider First Line Business Practice Location Address |
1934 PROSPECT DR |
The first name of the provider, if the provider
is an individual. |
Provider Business Practice Location Address City Name |
PALMER |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
AK |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
99645 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Telephone Number |
9077467842 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
7/26/2017 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
7/26/2017 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Gender Code |
M |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
225700000X |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
N |
|