{
"Npi": {
"NPI": "1255513891",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WARREN URGENT CARE PC",
"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": "L-4372",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLUMBUS",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43260-0001",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "586-276-8200",
"MailingAddressFaxNumber": "586-276-8181",
"FirstLinePracticeLocationAddress": "31700 VAN DYKE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WARREN",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48093-7949",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "586-276-8200",
"PracticeLocationAddressFaxNumber": "586-276-8181",
"EnumerationDate": "12/05/2007",
"LastUpdateDate": "10/17/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IFTIKHAR",
"AuthorizedOfficialFirstName": "FARAH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "586-276-8200",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": "4301065784",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}