{
"Npi": {
"NPI": "1174073597",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "UNITYPOINT CLINIC URGENT CARE",
"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": "802 KENYON RD",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "FORT DODGE",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "50501-5740",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "515-574-8484",
"MailingAddressFaxNumber": "515-574-8483",
"FirstLinePracticeLocationAddress": "802 KENYON RD",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "FORT DODGE",
"PracticeLocationAddressStateName": "IA",
"PracticeLocationAddressPostalCode": "50501-5740",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "515-574-8484",
"PracticeLocationAddressFaxNumber": "515-574-8483",
"EnumerationDate": "10/10/2016",
"LastUpdateDate": "10/10/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RANDALL",
"AuthorizedOfficialFirstName": "LISA",
"AuthorizedOfficialMiddleName": "RENEE",
"AuthorizedOfficialTitle": "CLINIC MANAGER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "515-574-8488",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": "A113462",
"LicenseNumberStateCode": "IA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}