{
"Npi": {
"NPI": "1124180427",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LANCASTER PA ENDOSCOPY ASC LLC",
"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": "2112 HARRISBURG PIKE",
"SecondLineMailingAddress": "SUITE 323",
"MailingAddressCityName": "LANCASTER",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17604",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "717-544-3569",
"MailingAddressFaxNumber": "717-544-3570",
"FirstLinePracticeLocationAddress": "2112 HARRISBURG PIKE",
"SecondLinePracticeLocationAddress": "SUITE 323",
"PracticeLocationAddressCityName": "LANCASTER",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "17604",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "717-544-3569",
"PracticeLocationAddressFaxNumber": "717-544-3570",
"EnumerationDate": "12/14/2006",
"LastUpdateDate": "03/14/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLENDENIN",
"AuthorizedOfficialFirstName": "PHILLIP",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "615-665-1283",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "17211501",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}