{
"Npi": {
"NPI": "1215980685",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FIRST CHOICE URGENT CARE CLINIC, 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": "2431 ALOMA AVE",
"SecondLineMailingAddress": "SUITE 111",
"MailingAddressCityName": "WINTER PARK",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32792-2540",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-677-1111",
"MailingAddressFaxNumber": "407-677-8883",
"FirstLinePracticeLocationAddress": "2040 COLLIER AVE",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "FORT MYERS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33901-8124",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "239-277-9151",
"PracticeLocationAddressFaxNumber": "239-277-1552",
"EnumerationDate": "05/18/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PIERRE",
"AuthorizedOfficialFirstName": "WILLIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "239-277-9151",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": "HCC6666",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}