{
"Npi": {
"NPI": "1124087176",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FORUM HEALTH",
"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": "3019 WHISPERING PINES DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CANFIELD",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44406-9649",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "330-518-4445",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "510 GYPSY LN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "YOUNGSTOWN",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44504-1349",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "330-884-3951",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/20/2006",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MUMFORD",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "330-884-3898",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "282NC2000X",
"TaxonomyName": "Children's Hospital",
"LicenseNumber": "35080434",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}