{
"Npi": {
"NPI": "1306221924",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SURGICAL ASSISTANCE",
"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": "6121 WINDEMERE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOVELAND",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80537-7012",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "720-626-3692",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6121 WINDEMERE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOVELAND",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80537-7012",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "720-626-3692",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/24/2015",
"LastUpdateDate": "09/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LINBOE",
"AuthorizedOfficialFirstName": "DEBRA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "720-626-3692",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "246ZC0007X",
"TaxonomyName": "Surgical Assistant",
"LicenseNumber": "1171",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AS0400X",
"TaxonomyName": "Surgical Physician Assistant",
"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."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}