{
"Npi": {
"NPI": "1285812362",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MAITLAND AVENUE URGENT CARE PA",
"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": "411 MAITLAND AVE",
"SecondLineMailingAddress": "SUITE 1002",
"MailingAddressCityName": "ALTAMONTE SPRINGS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32701-5448",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "321-207-0002",
"MailingAddressFaxNumber": "321-207-0003",
"FirstLinePracticeLocationAddress": "411 MAITLAND AVE STE 1002",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALTAMONTE SPRINGS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32701-5448",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "321-207-0002",
"PracticeLocationAddressFaxNumber": "321-207-2003",
"EnumerationDate": "01/31/2008",
"LastUpdateDate": "02/13/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOHNSON",
"AuthorizedOfficialFirstName": "SETH",
"AuthorizedOfficialMiddleName": "T",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "321-207-0002",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": "OS5330",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}