{
"Npi": {
"NPI": "1316268154",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MERRITT MEDICAL & PROFESSIONAL",
"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": "1511 CRYSTAL VALLEY CT SE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CALEDONIA",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49316-8118",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "616-656-3199",
"MailingAddressFaxNumber": "616-656-3199",
"FirstLinePracticeLocationAddress": "1511 CRYSTAL VALLEY CT SE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CALEDONIA",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49316-8118",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "616-656-3199",
"PracticeLocationAddressFaxNumber": "616-656-3199",
"EnumerationDate": "06/16/2010",
"LastUpdateDate": "06/16/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MERRITT",
"AuthorizedOfficialFirstName": "CARLOS",
"AuthorizedOfficialMiddleName": "SCOTT",
"AuthorizedOfficialTitle": "PHYSICIAN/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "616-656-3199",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "4301069990",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "313M00000X",
"TaxonomyName": "Nursing Facility/Intermediate Care Facility",
"LicenseNumber": "4301069990",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "320900000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility",
"LicenseNumber": "4301069990",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "282N00000X",
"TaxonomyName": "General Acute Care Hospital",
"LicenseNumber": "4301069990",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}