{
"Npi": {
"NPI": "1205895844",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BOCA PATHOLOGY 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": "PO BOX 63069",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHARLESTON",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29406",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-229-4311",
"MailingAddressFaxNumber": "305-229-4388",
"FirstLinePracticeLocationAddress": "800 MEADOWS RD",
"SecondLinePracticeLocationAddress": "BOCA COMMUNITY HOSPITAL",
"PracticeLocationAddressCityName": "BOCA RATON",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33486",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-955-4136",
"PracticeLocationAddressFaxNumber": "561-955-5268",
"EnumerationDate": "03/22/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRITO",
"AuthorizedOfficialFirstName": "MIGUEL",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "561-955-4136",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207ZP0102X",
"TaxonomyName": "Anatomic Pathology & Clinical Pathology Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}