{
"Npi": {
"NPI": "1316143332",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HEATHROW IMAGING 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": "1343 SOUTH INTERNATIONAL PARKWAY",
"SecondLineMailingAddress": "SUITE 1351 BLDG 3",
"MailingAddressCityName": "LAKE MARY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32746",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-333-4464",
"MailingAddressFaxNumber": "407-333-4393",
"FirstLinePracticeLocationAddress": "1343 S INTERNATIONAL PKWY",
"SecondLinePracticeLocationAddress": "SUITE 1351 BLDG 3",
"PracticeLocationAddressCityName": "LAKE MARY",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32746-1401",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-333-4464",
"PracticeLocationAddressFaxNumber": "407-333-4393",
"EnumerationDate": "06/26/2007",
"LastUpdateDate": "07/10/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARDIN",
"AuthorizedOfficialFirstName": "LAVELLE",
"AuthorizedOfficialMiddleName": "R",
"AuthorizedOfficialTitle": "CREDENTIALING COORDINATOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "615-344-8203",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QM1200X",
"TaxonomyName": "Magnetic Resonance Imaging (MRI) Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QR0206X",
"TaxonomyName": "Mammography Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QR0200X",
"TaxonomyName": "Radiology Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}