{
"Npi": {
"NPI": "1285795567",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PIKES PEAK CENTER FOR COLON & RECTAL SURGERY",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "559 EAST PIKES PEAK AVE",
"SecondLineMailingAddress": "SUITE #300",
"MailingAddressCityName": "COLORADO SPRINGS",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80903",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "719-635-0454",
"MailingAddressFaxNumber": "719-473-3476",
"FirstLinePracticeLocationAddress": "559 EAST PIKES PEAK AVE",
"SecondLinePracticeLocationAddress": "SUITE #300",
"PracticeLocationAddressCityName": "COLORADO SPRINGS",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80903",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "719-635-0454",
"PracticeLocationAddressFaxNumber": "719-473-3476",
"EnumerationDate": "12/12/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RUDOLPH",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "G.",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "719-635-0454",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208C00000X",
"TaxonomyName": "Colon & Rectal Surgery Physician",
"LicenseNumber": "42378",
"LicenseNumberStateCode": "CO",
"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."
}
}
}
}