| NPI |
1003268533 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
| 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 |
PAGE |
The last name of the provider. If the provider is an individual, this is the legal name. |
| Provider First Name |
IVIE |
The first name of the provider, if the provider
is an individual. |
| Provider First Line Business Practice Location Address |
1518 AIRPORT RD |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
| Provider Business Practice Location Address City Name |
HINESVILLE |
The city name in the location address of the provider being identified. |
| Provider Business Practice Location Address State Name |
GA |
The State code in the location of the provider
being identified. |
| Provider Business Practice Location Address Postal Code |
313139439 |
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 country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Telephone Number |
9125595536 |
The telephone number associated with the location address of the provider being identified. |
| Provider Business Practice Location Address Fax Number |
6143883712 |
The fax number associated with the location
address of the provider being identified. |
| Provider Enumeration Date |
7/8/2016 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date |
5/20/2021 |
The date that a record was last updated or changed. |
| Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
| Healthcare Provider Taxonomy Code 1 |
101YP2500X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
| Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| NPI Certification Date |
5/20/2021 |
|