{
"Npi": {
"NPI": "1013274364",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SERVANT HEALTHCARE, PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "10700 N RODNEY PARHAM ROAD",
"SecondLineMailingAddress": "STE C-10A",
"MailingAddressCityName": "LITTLE ROCK",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72212",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "501-246-7274",
"MailingAddressFaxNumber": "501-421-4161",
"FirstLinePracticeLocationAddress": "10700 N RODNEY PARHAM ROAD",
"SecondLinePracticeLocationAddress": "STE C-10A",
"PracticeLocationAddressCityName": "LITTLE ROCK",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72212",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "501-246-7274",
"PracticeLocationAddressFaxNumber": "501-421-4161",
"EnumerationDate": "04/11/2012",
"LastUpdateDate": "11/05/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WARFORD",
"AuthorizedOfficialFirstName": "JEREMY",
"AuthorizedOfficialMiddleName": "ALAN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "501-920-2252",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "BL00123175",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}