{
"Npi": {
"NPI": "1215008941",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WEST FLORIDA PET SERVICES LLC",
"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": "510 VONDERBURG DR",
"SecondLineMailingAddress": "SUITE 3009",
"MailingAddressCityName": "BRANDON",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33511-5980",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "813-657-4914",
"MailingAddressFaxNumber": "813-657-4916",
"FirstLinePracticeLocationAddress": "510 VONDERBURG DR",
"SecondLinePracticeLocationAddress": "SUITE 3009",
"PracticeLocationAddressCityName": "BRANDON",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33511-5980",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "813-657-4914",
"PracticeLocationAddressFaxNumber": "813-657-4916",
"EnumerationDate": "11/13/2006",
"LastUpdateDate": "12/03/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARDIN",
"AuthorizedOfficialFirstName": "LAVELLE",
"AuthorizedOfficialMiddleName": "R",
"AuthorizedOfficialTitle": "ANALYST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "615-344-8203",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QR0207X",
"TaxonomyName": "Mobile Mammography Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QR0208X",
"TaxonomyName": "Mobile Radiology Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2085R0202X",
"TaxonomyName": "Diagnostic Radiology 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."
}
}
}
}