{
"Npi": {
"NPI": "1326346800",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TEA HOUSE ACUPUNCTURE 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": "835 GENEVA PKWY N",
"SecondLineMailingAddress": "SUITE #3",
"MailingAddressCityName": "LAKE GENEVA",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53147-5700",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-248-3800",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "835 GENEVA PKWY N",
"SecondLinePracticeLocationAddress": "SUITE #3",
"PracticeLocationAddressCityName": "LAKE GENEVA",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53147-5700",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-248-3800",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/07/2011",
"LastUpdateDate": "03/07/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STERN",
"AuthorizedOfficialFirstName": "JULIANN",
"AuthorizedOfficialMiddleName": "CAMILLE",
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CA, LAC, MSOM",
"AuthorizedOfficialTelephoneNumber": "262-248-3800",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "171100000X",
"TaxonomyName": "Acupuncturist",
"LicenseNumber": "706055",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}