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Authorized Official Title or Position. The fax number associated with the mailing address of the provider being identified. Healthcare Provider Taxonomy 1. Other Provider Identifier State 1. This data element may contain the same information as ''Provider location address fax number''. ZIP code plus 4-digit extension, if available. For providers with more than one physical location, this is the primary location.

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Healthcare Provider Taxonomy Group 1. If the provider is an individual, this is the legal name. The date the provider was assigned a unique identifier assigned an NPI. This data element may contain the same information as ''Provider location address State name''. This data element may contain the same information as ''Provider location address fax number''. Provider Business Mailing Address Telephone Number The telephone number associated with mailing address of the provider being identified.

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The first name of the provider, if the provider is an individual. Healthcare Provider Taxonomy Code 1. The second line mailing address of the provider being identified. In a sole proprietorship, the sole proprietor owns all of the assets of the business and is solely liable for all of the debts of the business. The State or Province name in the location address of the provider being identified.