{
"Npi": {
"NPI": "1073595096",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MID-SOUTH HEALTH CLINIC 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": "233 E CENTER DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALTON",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62002-5931",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "618-465-7717",
"MailingAddressFaxNumber": "618-465-7710",
"FirstLinePracticeLocationAddress": "3100 WARRIOR LN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "POPLAR BLUFF",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63901-8686",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "573-785-0851",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/16/2005",
"LastUpdateDate": "07/10/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARTIN",
"AuthorizedOfficialFirstName": "JOETTA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "573-785-0851",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR1300X",
"TaxonomyName": "Rural Health Clinic/Center",
"LicenseNumber": "031640",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}