{
"Npi": {
"NPI": "1205097060",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TECSON FAMILY PRACTICE INC",
"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": "725 S 6TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MACCLENNY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32063",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-259-3150",
"MailingAddressFaxNumber": "904-259-7890",
"FirstLinePracticeLocationAddress": "725 S 6TH ST",
"SecondLinePracticeLocationAddress": "MACCLE",
"PracticeLocationAddressCityName": "MACCLENNY",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32063",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-259-3150",
"PracticeLocationAddressFaxNumber": "904-259-7890",
"EnumerationDate": "06/24/2008",
"LastUpdateDate": "09/29/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TECSON",
"AuthorizedOfficialFirstName": "ANGELITO",
"AuthorizedOfficialMiddleName": "B",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "904-259-3150",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "00ME28296",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}