{
"Npi": {
"NPI": "1063930626",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "STOW RECOVERY SPECIALISTS, 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": "4502 DARROW RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STOW",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44224",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "330-915-2990",
"MailingAddressFaxNumber": "888-746-3547",
"FirstLinePracticeLocationAddress": "4502 DARROW RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STOW",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44224",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "330-915-2990",
"PracticeLocationAddressFaxNumber": "888-746-3547",
"EnumerationDate": "09/05/2017",
"LastUpdateDate": "09/05/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOLB",
"AuthorizedOfficialFirstName": "JASON",
"AuthorizedOfficialMiddleName": "TODD",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "330-414-4599",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}