{
"Npi": {
"NPI": "1114893252",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JOHNSON PROSTHETICS & ORTHOTICS LLC",
"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": "1742 E JOYCE BLVD STE 1",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FAYETTEVILLE",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72703-5260",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "479-485-3366",
"MailingAddressFaxNumber": "479-485-3305",
"FirstLinePracticeLocationAddress": "1742 E JOYCE BLVD STE 1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FAYETTEVILLE",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72703-5260",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "479-485-3366",
"PracticeLocationAddressFaxNumber": "479-485-3305",
"EnumerationDate": "10/15/2025",
"LastUpdateDate": "10/15/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOHNSON",
"AuthorizedOfficialFirstName": "GREG",
"AuthorizedOfficialMiddleName": "ANTHONY",
"AuthorizedOfficialTitle": "CPO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CPO",
"AuthorizedOfficialTelephoneNumber": "417-726-9964",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}