{
"Npi": {
"NPI": "1295719037",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NORTHWEST FLORIDA CARDIOLOGY 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": "490 HIGHWAY 85 N",
"SecondLineMailingAddress": "STE A & B",
"MailingAddressCityName": "NICEVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32578-1010",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-678-6501",
"MailingAddressFaxNumber": "850-678-6516",
"FirstLinePracticeLocationAddress": "490 HIGHWAY 85 N",
"SecondLinePracticeLocationAddress": "STE A & B",
"PracticeLocationAddressCityName": "NICEVILLE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32578-1010",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "850-678-6501",
"PracticeLocationAddressFaxNumber": "850-678-6516",
"EnumerationDate": "12/05/2005",
"LastUpdateDate": "05/10/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PICKLER",
"AuthorizedOfficialFirstName": "MICKEY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "VP",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "850-523-2117",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RC0000X",
"TaxonomyName": "Cardiovascular Disease Physician",
"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."
}
}
}
}