{
"Npi": {
"NPI": "1013045806",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DIVERSIFIED MEDICAL DISTRIBUTION 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": "3035 E PATRICK LN",
"SecondLineMailingAddress": "STE # 1",
"MailingAddressCityName": "LAS VEGAS",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89120-4930",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "866-660-0567",
"MailingAddressFaxNumber": "866-425-6020",
"FirstLinePracticeLocationAddress": "3035 E PATRICK LN",
"SecondLinePracticeLocationAddress": "STE # 1",
"PracticeLocationAddressCityName": "LAS VEGAS",
"PracticeLocationAddressStateName": "NV",
"PracticeLocationAddressPostalCode": "89120-4930",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "866-660-0567",
"PracticeLocationAddressFaxNumber": "866-425-6020",
"EnumerationDate": "03/01/2007",
"LastUpdateDate": "10/21/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RASTINEHAD",
"AuthorizedOfficialFirstName": "RAMEEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BSBA",
"AuthorizedOfficialTelephoneNumber": "800-348-6337",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "MP00275",
"LicenseNumberStateCode": "NV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}