{
"Npi": {
"NPI": "1235395724",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WORKERS' COMPENSATION MEDICAL CONSULTING, LC",
"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": "16282 AUDUBON VILLAGE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WILDWOOD",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63040-1710",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-302-0623",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2638 HIGHWAY 109",
"SecondLinePracticeLocationAddress": "SUITE 101",
"PracticeLocationAddressCityName": "WILDWOOD",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63040-1161",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "636-730-3177",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/04/2008",
"LastUpdateDate": "08/04/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOLLMAN",
"AuthorizedOfficialFirstName": "MARY",
"AuthorizedOfficialMiddleName": "ANN",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD, MS, CIME",
"AuthorizedOfficialTelephoneNumber": "636-730-3177",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QX0100X",
"TaxonomyName": "Occupational Medicine Clinic/Center",
"LicenseNumber": "R9N85",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}