{
"Npi": {
"NPI": "1154709863",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CALDWELL IMMEDIATE CARE",
"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": "2701 CARRIAGE WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TWIN FALLS",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83301-5257",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-320-0258",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2701 CARRIAGE WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TWIN FALLS",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83301-5257",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-320-0258",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/13/2015",
"LastUpdateDate": "05/26/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PITTARD",
"AuthorizedOfficialFirstName": "JONATHAN",
"AuthorizedOfficialMiddleName": "BRUCE",
"AuthorizedOfficialTitle": "OWNER/PROVIDER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "P.A.",
"AuthorizedOfficialTelephoneNumber": "208-320-0258",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "SPHY-345",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}