{
"Npi": {
"NPI": "1346538279",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ADELAIDE HEALTHCARE GROUP, 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": "1123 WESTMINISTER AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MURPHY",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75094-4158",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "214-755-9999",
"MailingAddressFaxNumber": "214-227-7871",
"FirstLinePracticeLocationAddress": "1123 WESTMINISTER AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MURPHY",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75094-4158",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "214-755-9999",
"PracticeLocationAddressFaxNumber": "214-227-7871",
"EnumerationDate": "07/12/2011",
"LastUpdateDate": "07/12/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JACOB",
"AuthorizedOfficialFirstName": "JACKSON",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "214-755-9999",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "171W00000X",
"TaxonomyName": "Contractor",
"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."
}
}
}
}