{
"Npi": {
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "PLASTIC SURGERY ASSOCIATES OF SOUTHERN INDIANA PC",
"LastName": null,
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"NamePrefix": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "PO BOX 1148",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BLOOMINGTON",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "47402-1148",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "812-336-6060",
"MailingAddressFaxNumber": "812-333-7760",
"FirstLinePracticeLocationAddress": "1455 W 2ND STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BLOOMINGTON",
"PracticeLocationAddressStateName": "IN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "812-336-6060",
"PracticeLocationAddressFaxNumber": "812-333-7760",
"EnumerationDate": "09/28/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WEBER",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "EDWARD",
"AuthorizedOfficialTitle": "PRESIDENT & CHAIR OF GOVERNING BODY",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "812-336-6060",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208200000X",
"TaxonomyName": "Plastic Surgery Physician",
"LicenseNumber": "50003776A",
"LicenseNumberStateCode": "IN",
"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."
}
}
}
}