{
"Npi": {
"NPI": "1083987002",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "PREMIER HEALTH CARE LLC",
"ParentOrgTIN": null,
"OrgName": "PREMIER URGENT CARE OF EASTGATE",
"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": "4530 EASTGATE BLVD",
"SecondLineMailingAddress": "STE B-616",
"MailingAddressCityName": "CINCINNATI",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45245-1266",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "513-752-1999",
"MailingAddressFaxNumber": "513-752-0914",
"FirstLinePracticeLocationAddress": "4530 EASTGATE BLVD",
"SecondLinePracticeLocationAddress": "STE B-616",
"PracticeLocationAddressCityName": "CINCINNATI",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45245-1266",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "513-752-1999",
"PracticeLocationAddressFaxNumber": "513-752-0914",
"EnumerationDate": "02/22/2012",
"LastUpdateDate": "02/22/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GIORDON",
"AuthorizedOfficialFirstName": "MACHELLE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CREDENTIALING SPECIALIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "330-723-2111",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}