{
"Npi": {
"NPI": "1023264934",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BORDERS-BLACKWELL MEDICAL & WELLNESS CORPORATION",
"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": "321 S SHARPE AVE",
"SecondLineMailingAddress": "POST OFFICE BOX 1998",
"MailingAddressCityName": "CLEVELAND",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "38732",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "662-843-8700",
"MailingAddressFaxNumber": "662-843-9100",
"FirstLinePracticeLocationAddress": "321 S SHARPE AVE",
"SecondLinePracticeLocationAddress": "POST OFFICE BOX 1998",
"PracticeLocationAddressCityName": "CLEVELAND",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "38732",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "662-843-8700",
"PracticeLocationAddressFaxNumber": "662-843-9100",
"EnumerationDate": "08/12/2008",
"LastUpdateDate": "06/16/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BORDERS-BLACKWELL",
"AuthorizedOfficialFirstName": "ANNIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO/PHYSICIAN",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "662-843-8700",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR1300X",
"TaxonomyName": "Rural Health Clinic/Center",
"LicenseNumber": "20725",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}