{
"Npi": {
"NPI": "1154561116",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JOSEPH W IPPOLITO JR MD PLLC",
"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": "526 SHOUP AVE W",
"SecondLineMailingAddress": "SUITE F",
"MailingAddressCityName": "TWIN FALLS",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83301-4591",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-736-7620",
"MailingAddressFaxNumber": "208-735-9537",
"FirstLinePracticeLocationAddress": "526 SHOUP AVE W",
"SecondLinePracticeLocationAddress": "SUITE F",
"PracticeLocationAddressCityName": "TWIN FALLS",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83301-4591",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-736-7620",
"PracticeLocationAddressFaxNumber": "208-735-9537",
"EnumerationDate": "03/03/2009",
"LastUpdateDate": "08/29/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IPPOLITO",
"AuthorizedOfficialFirstName": "JOSEPH",
"AuthorizedOfficialMiddleName": "W",
"AuthorizedOfficialTitle": "MEDICAL DOCTOR/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "208-736-7620",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "305R00000X",
"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": "M7008",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}