{
"Npi": {
"NPI": "1174874143",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NORTHERN ORTHOTICS & PROSTHETICS",
"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": "1015 COMMERCE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MARQUETTE",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49855-8694",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "906-273-2444",
"MailingAddressFaxNumber": "906-353-7000",
"FirstLinePracticeLocationAddress": "1015 COMMERCE DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MARQUETTE",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49855-8694",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "906-273-2444",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/01/2012",
"LastUpdateDate": "09/22/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROY",
"AuthorizedOfficialFirstName": "JEFFERY",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "C.P.O.",
"AuthorizedOfficialTelephoneNumber": "906-353-7161",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}