{
"Npi": {
"NPI": "1023478435",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LA MISS DIABETIC SHOES",
"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": "139 SOUTHERN RIDGE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MADISON",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39110-9484",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-883-3342",
"MailingAddressFaxNumber": "601-856-5955",
"FirstLinePracticeLocationAddress": "2200 HIGHWAY 61 N",
"SecondLinePracticeLocationAddress": "SUITE 3400",
"PracticeLocationAddressCityName": "VICKSBURG",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39183-8246",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-883-3342",
"PracticeLocationAddressFaxNumber": "601-856-5955",
"EnumerationDate": "02/26/2016",
"LastUpdateDate": "02/26/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PHELAN",
"AuthorizedOfficialFirstName": "STEPHANIE",
"AuthorizedOfficialMiddleName": "F",
"AuthorizedOfficialTitle": "OWNER/PROVIDER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "601-883-3342",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "80145",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}