{
"Npi": {
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "COASTAL CAROLINA HOSPITAL",
"ParentOrgTIN": null,
"OrgName": "COASTAL CAROLINA MEDICAL CENTER, INC.",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 741261",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30374-1261",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "843-784-8293",
"MailingAddressFaxNumber": "843-784-7801",
"FirstLinePracticeLocationAddress": "1010 MEDICAL CENTER DR",
"SecondLinePracticeLocationAddress": "SUITE 240",
"PracticeLocationAddressCityName": "HARDEEVILLE",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29927-3447",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "843-784-8293",
"PracticeLocationAddressFaxNumber": "843-784-7801",
"EnumerationDate": "02/02/2011",
"LastUpdateDate": "03/22/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GROTELUSCHEN",
"AuthorizedOfficialFirstName": "RON",
"AuthorizedOfficialMiddleName": "O.",
"AuthorizedOfficialTitle": "CFO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "843-784-8076",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR1300X",
"TaxonomyName": "Rural Health Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}