{
"Npi": {
"NPI": "1003479387",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LOUISIANA MEDSHIELD LLC",
"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": "430 CORPORATE DR STE A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HOUMA",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70360-2514",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "985-333-1421",
"MailingAddressFaxNumber": "985-262-4651",
"FirstLinePracticeLocationAddress": "430 CORPORATE DR STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HOUMA",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "70360-2514",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "985-333-1421",
"PracticeLocationAddressFaxNumber": "985-262-4651",
"EnumerationDate": "04/22/2019",
"LastUpdateDate": "03/25/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PORCHE",
"AuthorizedOfficialFirstName": "BEAU",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "AUTHORIZED OFFICIAL/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "985-873-8586",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207L00000X",
"TaxonomyName": "Anesthesiology Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207LP2900X",
"TaxonomyName": "Pain Medicine (Anesthesiology) Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}