{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "SOUTH SHORE FOOT AND ANKLE INC",
"LastName": null,
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"MiddleName": null,
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"FirstLineMailingAddress": "27 ASPEN RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PORTAGE",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46368-1027",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "219-464-4100",
"MailingAddressFaxNumber": "219-464-4114",
"FirstLinePracticeLocationAddress": "1101 GLENDALE BLVD STE 101",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "VALPARAISO",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "46383-3769",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "219-464-4100",
"PracticeLocationAddressFaxNumber": "219-464-4114",
"EnumerationDate": "06/18/2012",
"LastUpdateDate": "07/29/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRUNDY",
"AuthorizedOfficialFirstName": "CYNTHIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "219-464-4100",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "07000941A",
"LicenseNumberStateCode": "IN",
"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."
}
}
}
}