{
"Npi": {
"NPI": "1265965818",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LICE CLINICS OF AMERICAN - CENTRAL MISSISSIPPI, 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": "PO BOX 2053",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MADISON",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39130-2053",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "655 LAKE HARBOUR DR",
"SecondLinePracticeLocationAddress": "SUITE 400",
"PracticeLocationAddressCityName": "RIDGELAND",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39157-4355",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-707-5712",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/10/2017",
"LastUpdateDate": "04/10/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SMALLING",
"AuthorizedOfficialFirstName": "CHRISTY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "601-707-5712",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "247200000X",
"TaxonomyName": "Other Technician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}