{
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"IsOrgSubpart": "N",
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"OrgName": "GREAT SOUTHWEST MEDICAL LLC",
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"FirstLineMailingAddress": "643 S GREAT SOUTHWEST PKWY",
"SecondLineMailingAddress": "SUITE 104",
"MailingAddressCityName": "GRAND PRAIRIE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75051-1056",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "643 S GREAT SOUTHWEST PKWY",
"SecondLinePracticeLocationAddress": "SUITE 104",
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"PracticeLocationAddressTelephoneNumber": "214-363-5400",
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"EnumerationDate": "07/18/2013",
"LastUpdateDate": "07/18/2013",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GUITREAU",
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"AuthorizedOfficialTelephoneNumber": "214-382-1909",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": "K0566",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}