{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "WICHITA FALLS ENDOSCOPY CENTER, LP",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "1500 9TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WICHITA FALLS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76301-4323",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "940-761-9034",
"MailingAddressFaxNumber": "940-761-7510",
"FirstLinePracticeLocationAddress": "1500 9TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WICHITA FALLS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76301-4323",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "940-761-9034",
"PracticeLocationAddressFaxNumber": "940-761-7510",
"EnumerationDate": "04/07/2015",
"LastUpdateDate": "04/07/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BESHEAR",
"AuthorizedOfficialFirstName": "BRANDON",
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"AuthorizedOfficialTitle": "ADMIISTRATOR",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "940-761-9034",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "8194",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}