{
"Npi": {
"NPI": "1215952023",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE BREAST CENTER",
"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": "5604 SW LEE BLVD",
"SecondLineMailingAddress": "SUITE 150",
"MailingAddressCityName": "LAWTON",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73505-9681",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "580-536-9729",
"MailingAddressFaxNumber": "580-536-2584",
"FirstLinePracticeLocationAddress": "5604 SW LEE BLVD",
"SecondLinePracticeLocationAddress": "SUITE 150",
"PracticeLocationAddressCityName": "LAWTON",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "73505-9681",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "580-536-9729",
"PracticeLocationAddressFaxNumber": "580-536-2584",
"EnumerationDate": "07/13/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PRESTON",
"AuthorizedOfficialFirstName": "MONIQUE",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "EXEC. CORP. DIRECTOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "580-536-9729",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0200X",
"TaxonomyName": "Radiology Clinic/Center",
"LicenseNumber": "141952",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}