{
"Npi": {
"NPI": "1073855193",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BUCKEYE ORAL & MAXILLOFACIAL SURGEY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 2443",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WESTERVILLE",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43086-2443",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "614-794-9700",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "110 POLARIS PARKWAY",
"SecondLinePracticeLocationAddress": "SUITE 110",
"PracticeLocationAddressCityName": "WESTERVILLE",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43082-0000",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "614-794-9700",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/27/2013",
"LastUpdateDate": "03/27/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCEWAN",
"AuthorizedOfficialFirstName": "JACK",
"AuthorizedOfficialMiddleName": "B",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "614-794-9700",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QS0112X",
"TaxonomyName": "Oral and Maxillofacial Surgery Clinic/Center",
"LicenseNumber": "30022456",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}