{
"Npi": {
"NPI": "1326904756",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "SOUTHERN CITIES COMMUNITY HEALTH CLINIC",
"ParentOrgTIN": null,
"OrgName": "SOUTHERN CITIES COMMUNITY HEALTH CLINIC",
"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": "3200 LABORE RD STE 104",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VADNAIS HEIGHTS",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55110-5186",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "651-539-7200",
"MailingAddressFaxNumber": "651-431-7505",
"FirstLinePracticeLocationAddress": "400 4TH ST NW STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FARIBAULT",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55021-5090",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "507-384-6830",
"PracticeLocationAddressFaxNumber": "651-431-7757",
"EnumerationDate": "12/30/2025",
"LastUpdateDate": "12/30/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ELLS",
"AuthorizedOfficialFirstName": "MELISSA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR AMBULATORY SERVI",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "651-539-7200",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223D0001X",
"TaxonomyName": "Public Health Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}