{
"Npi": {
"NPI": "1003072398",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DR. RICK L HOUDERSHELDT, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3705 TEAYS VALLEY RD",
"SecondLineMailingAddress": "SUITE 202",
"MailingAddressCityName": "HURRICANE",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "25526-8757",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-757-6990",
"MailingAddressFaxNumber": "304-757-0911",
"FirstLinePracticeLocationAddress": "3705 TEAYS VALLEY RD",
"SecondLinePracticeLocationAddress": "SUITE 202",
"PracticeLocationAddressCityName": "HURRICANE",
"PracticeLocationAddressStateName": "WV",
"PracticeLocationAddressPostalCode": "25526-8757",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-757-6990",
"PracticeLocationAddressFaxNumber": "304-757-0912",
"EnumerationDate": "08/06/2008",
"LastUpdateDate": "04/01/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOUDERSHELDT",
"AuthorizedOfficialFirstName": "RICK",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "304-757-6990",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "789",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}