{
"Npi": {
"NPI": "1144342338",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GERIATRIC FOOT CARE OF W VIR",
"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": "9016 TAYLORSVILLE RD",
"SecondLineMailingAddress": "SUITE 101",
"MailingAddressCityName": "LOUISVILLE",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40299-1750",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "502-724-0900",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2620 FAIRMONT AVE",
"SecondLinePracticeLocationAddress": "SUITE 203",
"PracticeLocationAddressCityName": "FAIRMONT",
"PracticeLocationAddressStateName": "WV",
"PracticeLocationAddressPostalCode": "26554-3494",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "502-724-0900",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/06/2007",
"LastUpdateDate": "11/16/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FOLICKMAN",
"AuthorizedOfficialFirstName": "STEPHEN",
"AuthorizedOfficialMiddleName": "R.",
"AuthorizedOfficialTitle": "DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.P.M.",
"AuthorizedOfficialTelephoneNumber": "502-724-0900",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213E00000X",
"TaxonomyName": "Podiatrist",
"LicenseNumber": "00142",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}