{
"Npi": {
"NPI": "1124156641",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PEDIATRIC & FAMILY URGENT CARE CTRS OF SO. FLA INC.",
"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": "PO BOX 143937",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORAL GABLES",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33114-3937",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-835-1551",
"MailingAddressFaxNumber": "305-835-7414",
"FirstLinePracticeLocationAddress": "705 E 26TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HIALEAH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33013-3823",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "305-835-1551",
"PracticeLocationAddressFaxNumber": "305-835-7414",
"EnumerationDate": "02/28/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PENABAD",
"AuthorizedOfficialFirstName": "EDGARDO",
"AuthorizedOfficialMiddleName": "BAYARDO",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "305-835-1551",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}