{
"Npi": {
"NPI": "1003081522",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EVANSTON SURGICAL CENTER LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "196 ARROWHEAD DR",
"SecondLineMailingAddress": "SUITE 8",
"MailingAddressCityName": "EVANSTON",
"MailingAddressStateName": "WY",
"MailingAddressPostalCode": "82930-8752",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "435-613-9500",
"MailingAddressFaxNumber": "435-613-9414",
"FirstLinePracticeLocationAddress": "196 ARROWHEAD DR",
"SecondLinePracticeLocationAddress": "SUITE 8",
"PracticeLocationAddressCityName": "EVANSTON",
"PracticeLocationAddressStateName": "WY",
"PracticeLocationAddressPostalCode": "82930-8752",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "307-789-1390",
"PracticeLocationAddressFaxNumber": "307-789-1391",
"EnumerationDate": "04/25/2008",
"LastUpdateDate": "10/20/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "O'CONNOR",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "OWNER/MD",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "307-789-1390",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "5079A",
"LicenseNumberStateCode": "WY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}