{
"Npi": {
"NPI": "1114143567",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ARIZONA PROSTHETIC ORTHOTICS SERVICES",
"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": "15855 N GREENWAY HAYDEN LOOP STE 140",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SCOTTSDALE",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85260-1660",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2933 N CAMPBELL AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TUCSON",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85719-2801",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "520-229-0622",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/17/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOETTL",
"AuthorizedOfficialFirstName": "ROGER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "COO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "520-229-0622",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": "07-668261-R",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}