{
"Npi": {
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "FARESI SURGICAL CARE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "11766 FOXBRIAR LAKE TRL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOYNTON BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33473-7830",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "606-465-4583",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2839 S SEACREST BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOYNTON BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33435-7934",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-732-2464",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/22/2017",
"LastUpdateDate": "03/17/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FARESI",
"AuthorizedOfficialFirstName": "MARIANO",
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"AuthorizedOfficialTitle": "MD",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "606-465-4583",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "ME96085",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}