{
"Npi": {
"NPI": "1306878996",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MOUNTAIN MOBILE DIAGNOSTICS, INC.",
"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": "PO BOX 896",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BULAN",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "41722-0896",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "606-487-9114",
"MailingAddressFaxNumber": "606-487-9114",
"FirstLinePracticeLocationAddress": "725 HARDBURLY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BULAN",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "41722-8907",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "606-487-9114",
"PracticeLocationAddressFaxNumber": "606-487-9114",
"EnumerationDate": "07/06/2006",
"LastUpdateDate": "12/01/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SPURLOCK",
"AuthorizedOfficialFirstName": "J",
"AuthorizedOfficialMiddleName": "B",
"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "R.T. (R)",
"AuthorizedOfficialTelephoneNumber": "606-487-9114",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335V00000X",
"TaxonomyName": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
"LicenseNumber": "720142",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}