{
"Npi": {
"NPI": "1265341291",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ADVENTHEALTH PRIMARY CARE RMR",
"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": "2600 WESTHALL LN STE 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MAITLAND",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32751-7107",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-200-2857",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "240 S ELIZABETH ST UNIT 103",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ELIZABETH",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80107-7546",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "303-269-2551",
"PracticeLocationAddressFaxNumber": "303-269-2552",
"EnumerationDate": "09/04/2026",
"LastUpdateDate": "09/04/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARCUS",
"AuthorizedOfficialFirstName": "DESTIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CFO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "225-328-1607",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR1300X",
"TaxonomyName": "Rural Health Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}