{
"Npi": {
"NPI": "1205011889",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PALOUSE FOOT & ANKLE CLINIC",
"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": "825 SE BISHOP BLVD",
"SecondLineMailingAddress": "801",
"MailingAddressCityName": "PULLMAN",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "99163-5517",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-882-8939",
"MailingAddressFaxNumber": "509-334-0380",
"FirstLinePracticeLocationAddress": "619 S WASHINGTON ST",
"SecondLinePracticeLocationAddress": "103",
"PracticeLocationAddressCityName": "MOSCOW",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83843-3090",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-882-8939",
"PracticeLocationAddressFaxNumber": "509-334-0380",
"EnumerationDate": "01/02/2008",
"LastUpdateDate": "01/24/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CAPAWANA",
"AuthorizedOfficialFirstName": "BRAD",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "509-334-4498",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "1298150002",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}