{
"Npi": {
"NPI": "1063592921",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NEVADA MEDICAL AND SURGICAL SUPPLY CORP",
"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": "269 CIELITO LINDO ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HENDERSON",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89012-4828",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "702-617-8894",
"MailingAddressFaxNumber": "702-617-8846",
"FirstLinePracticeLocationAddress": "3175 W ALI BABA LN",
"SecondLinePracticeLocationAddress": "SUITE 802",
"PracticeLocationAddressCityName": "LAS VEGAS",
"PracticeLocationAddressStateName": "NV",
"PracticeLocationAddressPostalCode": "89118-1611",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "702-855-0092",
"PracticeLocationAddressFaxNumber": "702-240-9096",
"EnumerationDate": "10/16/2006",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PATTERSON",
"AuthorizedOfficialFirstName": "SHERRY",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "VP OF OPERATIONS/SECRETARY",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "702-617-8894",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": "NV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}