{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "B & S UNITED AGENCY D/B/A MIRACLE EAR",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1321 W SAINTE MARIES ST STE A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PERRYVILLE",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63775-1596",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "573-547-2346",
"MailingAddressFaxNumber": "573-547-6228",
"FirstLinePracticeLocationAddress": "1321 W SAINTE MARIES ST STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PERRYVILLE",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63775-1596",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "573-547-2346",
"PracticeLocationAddressFaxNumber": "573-547-6228",
"EnumerationDate": "10/23/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HILL-COOLEY",
"AuthorizedOfficialFirstName": "JOYCE",
"AuthorizedOfficialMiddleName": "A.",
"AuthorizedOfficialTitle": "FRANCHISEE",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "R.N., BC-HIS",
"AuthorizedOfficialTelephoneNumber": "573-547-2346",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "237700000X",
"TaxonomyName": "Hearing Instrument Specialist",
"LicenseNumber": "000816",
"LicenseNumberStateCode": "MO",
"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."
}
}
}
}