{
"Npi": {
"NPI": "1013236462",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FWL MEDICAL, 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": "PO BOX 6574",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANTA BARBARA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "93160-6574",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "800-667-9795",
"MailingAddressFaxNumber": "805-686-9140",
"FirstLinePracticeLocationAddress": "1109 W HIGHWAY 246",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BUELLTON",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93427-9403",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "800-667-9795",
"PracticeLocationAddressFaxNumber": "805-686-9140",
"EnumerationDate": "05/25/2010",
"LastUpdateDate": "06/17/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEATHERBURY",
"AuthorizedOfficialFirstName": "FRANK",
"AuthorizedOfficialMiddleName": "WAYNE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "II",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "800-667-9795",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "101339365",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}