{
"Npi": {
"NPI": "1326348152",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NOLEN CLINIC LTD.",
"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": "PO BOX 8",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WEST FRANKFORT",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62896-0008",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "618-937-4164",
"MailingAddressFaxNumber": "618-932-3203",
"FirstLinePracticeLocationAddress": "107 S VAN BUREN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WEST FRANKFORT",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62896-2907",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "618-937-4164",
"PracticeLocationAddressFaxNumber": "618-932-3203",
"EnumerationDate": "10/27/2010",
"LastUpdateDate": "10/27/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NOLEN",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": "ALAN",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "618-937-4164",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": "038003613",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}