{
"Npi": {
"NPI": "1144686676",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FLAWLESS SERVICE CORPORATION",
"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": "PO BOX 804193",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60680-4103",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "312-222-0030",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1272 WINSTON PLZ",
"SecondLinePracticeLocationAddress": "MELROSE PARK CLINIC",
"PracticeLocationAddressCityName": "MELROSE PARK",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60160-1507",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-615-7546",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/13/2016",
"LastUpdateDate": "01/13/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TINLEY",
"AuthorizedOfficialFirstName": "ELTON",
"AuthorizedOfficialMiddleName": "XAVIER",
"AuthorizedOfficialTitle": "PHYSICIAN/SURGEON",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "312-222-0030",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": "036079325",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}