{
"Npi": {
"NPI": "1053523035",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "IMAGE AMERICA I, LLC",
"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": "11617 KATY FREEWAY",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "HOUSTON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77079",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "281-598-8383",
"MailingAddressFaxNumber": "281-598-6969",
"FirstLinePracticeLocationAddress": "11617 KATY FREEWAY",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "HOUSTON",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77079",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "281-598-8383",
"PracticeLocationAddressFaxNumber": "281-598-6969",
"EnumerationDate": "05/04/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOBLEY",
"AuthorizedOfficialFirstName": "BRIAN",
"AuthorizedOfficialMiddleName": "DAVID",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "713-660-8383",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0200X",
"TaxonomyName": "Radiology Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}