{
"Npi": {
"NPI": "1255596490",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ORTHOPAEDIC RECONSTRUCTIVE SUB-SPECIALISTS 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": "1233 WAYNE GILMORE CIR",
"SecondLineMailingAddress": "SUITE 250-A",
"MailingAddressCityName": "OPELOUSAS",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70570-6405",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "337-948-8556",
"MailingAddressFaxNumber": "337-948-6881",
"FirstLinePracticeLocationAddress": "1233 WAYNE GILMORE CIR",
"SecondLinePracticeLocationAddress": "SUITE 250-A",
"PracticeLocationAddressCityName": "OPELOUSAS",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "70570-6405",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "337-948-8556",
"PracticeLocationAddressFaxNumber": "337-948-6881",
"EnumerationDate": "07/28/2008",
"LastUpdateDate": "07/28/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FENN",
"AuthorizedOfficialFirstName": "PAUL",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "OWNER / OPERATOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "337-948-8556",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "200825",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}