{
"Npi": {
"NPI": "1245082981",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "DAVITA INC",
"ParentOrgTIN": null,
"OrgName": "MONTEER DIALYSIS LLC",
"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": "5200 VIRGINIA WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRENTWOOD",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37027-7569",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1426 LAKE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STORM LAKE",
"PracticeLocationAddressStateName": "IA",
"PracticeLocationAddressPostalCode": "50588-1910",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "712-732-6900",
"PracticeLocationAddressFaxNumber": "712-732-6906",
"EnumerationDate": "04/04/2024",
"LastUpdateDate": "04/04/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WEY",
"AuthorizedOfficialFirstName": "SAMUEL",
"AuthorizedOfficialMiddleName": "T",
"AuthorizedOfficialTitle": "VP, LICENSURE AND CERTIFICATION",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "615-341-6691",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QE0700X",
"TaxonomyName": "End-Stage Renal Disease (ESRD) Treatment Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}