{
"Npi": {
"NPI": "1144607862",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DEKALB SURGICAL SERVICES, 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": "2240 GATEWAY DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SYCAMORE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60178-3103",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "815-756-8571",
"MailingAddressFaxNumber": "815-756-5603",
"FirstLinePracticeLocationAddress": "2515 KLEIN ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SYCAMORE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60178",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "815-756-8571",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/01/2015",
"LastUpdateDate": "02/05/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NEAL",
"AuthorizedOfficialFirstName": "GEORGE",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "CHIEF EXECUTIVE OFFICER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "469-214-0144",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}