{
"Npi": {
"NPI": "1154110575",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TIPLERSVILLE FAMILY MEDICAL CLINIC",
"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": "2820 COUNTY ROAD 301",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FALKNER",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "38629-9321",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "662-882-3635",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "24111 HIGHWAY 15",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TIPLERSVILLE",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "38674",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "662-672-7527",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/02/2025",
"LastUpdateDate": "05/02/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HEAVENER",
"AuthorizedOfficialFirstName": "CANDICE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PROVIDER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "NP",
"AuthorizedOfficialTelephoneNumber": "662-672-7527",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}