{
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"OrgName": "EMCC AZLE FAMILY PRACTICE LLC",
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"FirstLineMailingAddress": "2300 MATLOCK RD STE 35",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MANSFIELD",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76063-5018",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "469-830-8200",
"MailingAddressFaxNumber": "469-830-8201",
"FirstLinePracticeLocationAddress": "601 NORTHWEST PKWY STE C",
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"PracticeLocationAddressCityName": "AZLE",
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"PracticeLocationAddressTelephoneNumber": "817-270-0788",
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"EnumerationDate": "02/12/2019",
"LastUpdateDate": "05/18/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NEWSOM",
"AuthorizedOfficialFirstName": "MICHELLE",
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"AuthorizedOfficialTitle": "VP OF OPERATIONS",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "817-271-2583",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}