{
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"EIN": null,
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"FirstLineMailingAddress": "2 SHIRCLIFF WAY",
"SecondLineMailingAddress": "SUITE 205",
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32204-4753",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-308-7220",
"MailingAddressFaxNumber": "904-308-7234",
"FirstLinePracticeLocationAddress": "2 SHIRCLIFF WAY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-308-7220",
"PracticeLocationAddressFaxNumber": "904-308-7234",
"EnumerationDate": "05/21/2007",
"LastUpdateDate": "09/19/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROMINE",
"AuthorizedOfficialFirstName": "DONNIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "SYSTEM COO",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "904-308-1290",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "5698230001",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}