{
"Npi": {
"NPI": "1114159357",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GUADALUPE VALLEY SURGICAL ASSOCIATES PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "420 E 6TH ST STE 104",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ODESSA",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "79761-4537",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "432-333-8400",
"MailingAddressFaxNumber": "432-333-8401",
"FirstLinePracticeLocationAddress": "420 E 6TH ST STE 104",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ODESSA",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "79761-4537",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "432-333-8400",
"PracticeLocationAddressFaxNumber": "432-333-8401",
"EnumerationDate": "08/21/2009",
"LastUpdateDate": "08/26/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FATH",
"AuthorizedOfficialFirstName": "STEVEN",
"AuthorizedOfficialMiddleName": "WADE",
"AuthorizedOfficialTitle": "OWNER/MD",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "432-333-8400",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "K8144",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}