{
"Npi": {
"NPI": "1073570552",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PHYSICIANS SURGICAL CENTER LLC",
"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": "3121 S TELEPHONE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOORE",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73160-2944",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "405-364-9789",
"MailingAddressFaxNumber": "405-447-4985",
"FirstLinePracticeLocationAddress": "3121 S TELEPHONE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MOORE",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "73160-2944",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "405-364-9789",
"PracticeLocationAddressFaxNumber": "405-447-4985",
"EnumerationDate": "04/27/2006",
"LastUpdateDate": "09/16/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WALLACE",
"AuthorizedOfficialFirstName": "RHONDA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "405-364-9789",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "0022",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}