{
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"FirstLineMailingAddress": "PO BOX 8492",
"SecondLineMailingAddress": null,
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"MailingAddressStateName": "MN",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "507-281-1107",
"FirstLinePracticeLocationAddress": "1405 MARION RD SE",
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"PracticeLocationAddressFaxNumber": "507-281-1107",
"EnumerationDate": "05/20/2008",
"LastUpdateDate": "05/20/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHARIF",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "COMMUNITY LEADER",
"AuthorizedOfficialTelephoneNumber": "507-271-9254",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "343900000X",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}