{
"Npi": {
"NPI": "1205286168",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CERTIFIED MEDICAL SUPPLY, 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": "3651 LINDELL RD",
"SecondLineMailingAddress": "SUITE D651",
"MailingAddressCityName": "LAS VEGAS",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89103-1254",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "702-851-5610",
"MailingAddressFaxNumber": "702-943-0233",
"FirstLinePracticeLocationAddress": "603 E 8TH ST STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PORT ANGELES",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98362-6251",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "360-406-5063",
"PracticeLocationAddressFaxNumber": "360-477-4283",
"EnumerationDate": "06/21/2016",
"LastUpdateDate": "08/17/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GIBBS",
"AuthorizedOfficialFirstName": "MATTHEW",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "702-793-9763",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "604-000-651",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}