{
"Npi": {
"NPI": "1164751582",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INTEGRA SPECIALTY GROUP, PA",
"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": "517 N CARRIER PKWY STE G",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRAND PRAIRIE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75050-5464",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-263-2424",
"MailingAddressFaxNumber": "972-263-5545",
"FirstLinePracticeLocationAddress": "517 N CARRIER PKWY STE G",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRAND PRAIRIE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75050-5464",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-263-2424",
"PracticeLocationAddressFaxNumber": "972-263-5545",
"EnumerationDate": "12/14/2009",
"LastUpdateDate": "12/14/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SLOANE",
"AuthorizedOfficialFirstName": "SPENCER",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "972-263-2424",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0401X",
"TaxonomyName": "Comprehensive Outpatient Rehabilitation Facility (CORF)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}