{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "YELLOWSTONE SPORTS MEDICINE AND BONE & JOINT CLINIC,LLC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": "6",
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"OtherFirstName": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "720 LINDSAY LN",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "CODY",
"MailingAddressStateName": "WY",
"MailingAddressPostalCode": "82414-4103",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "307-578-1992",
"MailingAddressFaxNumber": "307-578-1990",
"FirstLinePracticeLocationAddress": "720 LINDSAY LN",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "CODY",
"PracticeLocationAddressStateName": "WY",
"PracticeLocationAddressPostalCode": "82414-4103",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "307-578-1992",
"PracticeLocationAddressFaxNumber": "307-578-1990",
"EnumerationDate": "02/29/2008",
"LastUpdateDate": "05/05/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BILES",
"AuthorizedOfficialFirstName": "JIMMIE",
"AuthorizedOfficialMiddleName": "GENE",
"AuthorizedOfficialTitle": "MANAGING MEMBER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "307-578-1953",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207X00000X",
"TaxonomyName": "Orthopaedic Surgery Physician",
"LicenseNumber": "3909A",
"LicenseNumberStateCode": "WY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}