{
"Npi": {
"NPI": "1154650331",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "POPLAR BLUFF NEUROLOGY CENTER, PC",
"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": "2210 BARRON RD",
"SecondLineMailingAddress": "SUITE 112",
"MailingAddressCityName": "POPLAR BLUFF",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63901-1908",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "573-785-0889",
"MailingAddressFaxNumber": "573-785-2011",
"FirstLinePracticeLocationAddress": "2210 BARRON RD",
"SecondLinePracticeLocationAddress": "SUITE 112",
"PracticeLocationAddressCityName": "POPLAR BLUFF",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63901-1908",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "573-785-0889",
"PracticeLocationAddressFaxNumber": "573-785-2011",
"EnumerationDate": "12/16/2009",
"LastUpdateDate": "03/11/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHOUDHARY",
"AuthorizedOfficialFirstName": "SHAHID",
"AuthorizedOfficialMiddleName": "KARIM",
"AuthorizedOfficialTitle": "PRESEDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "573-785-0889",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "104541",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}