{
"Npi": {
"NPI": "1326223041",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HM CENTRAL LAB, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2944 MOTLEY DR STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MESQUITE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75150-3405",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-613-5793",
"MailingAddressFaxNumber": "972-613-7236",
"FirstLinePracticeLocationAddress": "2944 MOTLEY DR",
"SecondLinePracticeLocationAddress": "SUITE 105",
"PracticeLocationAddressCityName": "MESQUITE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75150-3460",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-613-5793",
"PracticeLocationAddressFaxNumber": "972-613-7236",
"EnumerationDate": "12/31/2007",
"LastUpdateDate": "01/25/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ENRIQUEZ",
"AuthorizedOfficialFirstName": "ROBERTO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "C.E.O.",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.T.",
"AuthorizedOfficialTelephoneNumber": "214-274-3478",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2083P0901X",
"TaxonomyName": "Public Health & General Preventive Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": "45D1014980",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}