{
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"EIN": null,
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"IsOrgSubpart": "N",
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"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 837",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROCKPORT",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78381-0837",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "361-239-5739",
"MailingAddressFaxNumber": "361-288-1175",
"FirstLinePracticeLocationAddress": "1521 W MARKET ST STE E",
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"PracticeLocationAddressCityName": "ROCKPORT",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78382-6221",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "362-239-5739",
"PracticeLocationAddressFaxNumber": "361-288-1175",
"EnumerationDate": "11/04/2019",
"LastUpdateDate": "02/15/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PRIDGEON",
"AuthorizedOfficialFirstName": "AARON",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "512-659-6446",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}