{
"Npi": {
"NPI": "1013698604",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRESTIGE MEDICAL CLINIC",
"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": "4699 N FEDERAL HWY # 209F-M",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "POMPANO BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33064-6510",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-800-6000",
"MailingAddressFaxNumber": "954-302-8409",
"FirstLinePracticeLocationAddress": "4699 N FEDERAL HWY STE 209F-M",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "POMPANO BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33064-6510",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-800-6000",
"PracticeLocationAddressFaxNumber": "954-302-8409",
"EnumerationDate": "07/27/2023",
"LastUpdateDate": "07/27/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JEAN",
"AuthorizedOfficialFirstName": "ROSE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINSTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "561-702-5740",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}