{
"Npi": {
"NPI": "1083747513",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JSC PEDORTHICS",
"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": "100 S STATE ST",
"SecondLineMailingAddress": "SUITE D",
"MailingAddressCityName": "BUNNELL",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32110-6114",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "386-437-0272",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2600 US HIGHWAY 1 S",
"SecondLinePracticeLocationAddress": "SUITE6",
"PracticeLocationAddressCityName": "ST AUGUSTINE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32086-6199",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-501-2306",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/13/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REEDY",
"AuthorizedOfficialFirstName": "SCOTT",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "PRES.",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "C.PED.",
"AuthorizedOfficialTelephoneNumber": "386-437-0272",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": "PED63",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}