{
"Npi": {
"NPI": "1255603874",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "ORCHARD MEDICAL CLINIC",
"ParentOrgTIN": null,
"OrgName": "ORCHARD MEDICAL CLINIC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7501 92ND AVENUE CT SW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKEWOOD",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98498-3973",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "253-588-0058",
"MailingAddressFaxNumber": "253-589-4862",
"FirstLinePracticeLocationAddress": "5320 ORCHARD ST W",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "UNIVERSITY PLACE",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98467-3633",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "253-474-7100",
"PracticeLocationAddressFaxNumber": "253-474-2677",
"EnumerationDate": "01/27/2012",
"LastUpdateDate": "02/16/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PACIO",
"AuthorizedOfficialFirstName": "GLENN",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "253-474-7100",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "MD000380965",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}