{
"Npi": {
"NPI": "1275912578",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "OREGON PEDORTHIC SERVICES INC",
"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": "PO BOX 608",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRESHAM",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97030-0154",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-491-1723",
"MailingAddressFaxNumber": "503-489-0706",
"FirstLinePracticeLocationAddress": "8301 SE 13TH AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PORTLAND",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97202-7101",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "971-254-8142",
"PracticeLocationAddressFaxNumber": "503-489-0706",
"EnumerationDate": "05/20/2015",
"LastUpdateDate": "05/20/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCCURTAIN",
"AuthorizedOfficialFirstName": "DOUGLAS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "C.PED",
"AuthorizedOfficialTelephoneNumber": "503-491-1723",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332BC3200X",
"TaxonomyName": "Customized Equipment (DME)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}