{
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"ParentOrgTIN": null,
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"FirstLineMailingAddress": "2217 NORTH TARRANT PKWY",
"SecondLineMailingAddress": "#211",
"MailingAddressCityName": "FORT WORTH",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76177-2220",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-922-7456",
"MailingAddressFaxNumber": "972-922-7104",
"FirstLinePracticeLocationAddress": "2217 NORTH TARRANT PKWY",
"SecondLinePracticeLocationAddress": "#211",
"PracticeLocationAddressCityName": "FORT WORTH",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-922-7456",
"PracticeLocationAddressFaxNumber": "972-922-7104",
"EnumerationDate": "02/07/2017",
"LastUpdateDate": "08/21/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EDWARDS",
"AuthorizedOfficialFirstName": "CARL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": "H.I.S.",
"AuthorizedOfficialTelephoneNumber": "972-922-7456",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "237700000X",
"TaxonomyName": "Hearing Instrument Specialist",
"LicenseNumber": "50644",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}