{
"Npi": {
"NPI": "1114973252",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FIRST STATE MEDICAL SUPPLY COMPANY",
"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": "305 E JACKSON ST",
"SecondLineMailingAddress": "SUITE 109",
"MailingAddressCityName": "HARLINGEN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78550-6888",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "956-428-3313",
"MailingAddressFaxNumber": "958-428-3397",
"FirstLinePracticeLocationAddress": "305 E JACKSON ST",
"SecondLinePracticeLocationAddress": "SUITE 109",
"PracticeLocationAddressCityName": "HARLINGEN",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78550-6888",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "956-428-3313",
"PracticeLocationAddressFaxNumber": "956-428-3397",
"EnumerationDate": "05/26/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "UBI",
"AuthorizedOfficialFirstName": "OKEZIE",
"AuthorizedOfficialMiddleName": "J.M.",
"AuthorizedOfficialTitle": "OWNER/DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "PHARM D",
"AuthorizedOfficialTelephoneNumber": "956-428-3313",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "0066891",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}