{
"Npi": {
"NPI": "1154872513",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PATRICE CHARLES LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6509 MELWOOD ST",
"SecondLineMailingAddress": "2232",
"MailingAddressCityName": "FORT WORTH",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76112-0917",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-683-8859",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6509 MELWOOD ST",
"SecondLinePracticeLocationAddress": "2232",
"PracticeLocationAddressCityName": "FORT WORTH",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76112-0917",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-683-8859",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/20/2016",
"LastUpdateDate": "10/20/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROBINSON",
"AuthorizedOfficialFirstName": "TARA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "817-683-8859",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "347C00000X",
"TaxonomyName": "Private Vehicle",
"LicenseNumber": "13098324",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}