{
"Npi": {
"NPI": "1124605910",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GRAND RIVER SURGERY CENTER, 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": "1090 TROWBRIDGE RD STE A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EAST LANSING",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48823-5220",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "517-282-0851",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1090 TROWBRIDGE RD STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EAST LANSING",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48823-5220",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "517-220-0240",
"PracticeLocationAddressFaxNumber": "517-200-4455",
"EnumerationDate": "03/26/2021",
"LastUpdateDate": "12/08/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DIETZEL",
"AuthorizedOfficialFirstName": "DOUGLAS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "517-488-8800",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}