Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 251300000X | Local Education Agency (LEA) | | | | No |
| 2 | 251B00000X | Case Management | | | | No |
| 3 | 251E00000X | Home Health | | | | No |
| 4 | 251G00000X | Hospice Care, Community Based | | | | No |
| 5 | 251J00000X | Nursing Care | | | | No |
| 6 | 251K00000X | Public Health or Welfare | | | | No |
| 7 | 251S00000X | Community/Behavioral Health | | | | No |
| 8 | 251T00000X | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | | | | No |
| 9 | 261QC1500X | Clinic/Center | Community Health | | | No |
| 10 | 261QC1800X | Clinic/Center | Corporate Health | | | No |
| 11 | 261QP2300X | Clinic/Center | Primary Care | | | No |
| 12 | 261QH0100X | Clinic/Center | Health Service | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 999999999999 | MEDICAID | OHIO | |
| 2 | 999999999999 | MEDICAID | WISCONSIN | |
| 3 | 999999999999 | MEDICAID | MISSISSIPPI | |
| 4 | 999999999999 | MEDICAID | ILLINOIS | |
| 5 | 999999999999 | MEDICAID | ALABAMA | |
| 6 | 999999999999 | MEDICAID | NORTH CAROLINA | |
| 7 | 999999999999 | MEDICAID | DELAWARE | |
| 8 | 999999999999 | MEDICAID | FLORIDA | |
| 9 | 999999999999 | MEDICAID | MISSOURI | |
| 10 | 999999999999 | MEDICAID | MASSACHUSETTS | |
| 11 | 999999999999 | MEDICAID | UTAH | |
| 12 | 999999999999 | MEDICAID | VIRGINIA | |
| 13 | 999999999999 | MEDICAID | VERMONT | |
| 14 | 999999999999 | MEDICAID | NEW JERSEY | |
| 15 | 999999999999 | MEDICAID | IOWA | |
| 16 | 999999999999 | MEDICAID | CONNECTICUT | |
| 17 | 999999999999 | MEDICAID | LOUISIANA | |
| 18 | 999999999999 | MEDICAID | HAWAII | |
| 19 | 999999999999 | MEDICAID | NEW YORK | |
| 20 | 999999999999 | MEDICAID | CALIFORNIA | |
| 21 | 999999999999 | MEDICAID | KENTUCKY | |
| 22 | 999999999999 | MEDICAID | ALASKA | |
| 23 | 999999999999 | MEDICAID | GEORGIA | |
| 24 | 999999999999 | MEDICAID | INDIANA | |
| 25 | 999999999999 | MEDICAID | COLORADO | |
| 26 | 999999999999 | MEDICAID | NEBRASKA | |
| 27 | 999999999999 | MEDICAID | DISTRICT OF COLUMBIA | |
| 28 | 999999999999 | MEDICAID | TEXAS | |
| 29 | 999999999999 | MEDICAID | MARYLAND | |
