{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "STRIDE PROSTHETICS LLC",
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"FirstName": null,
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"NamePrefix": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 611",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FLATWOODS",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "41139-0611",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6319 E US HIGHWAY 36 STE 203",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "AVON",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "46123-6210",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "317-526-4700",
"PracticeLocationAddressFaxNumber": "888-508-6271",
"EnumerationDate": "03/23/2017",
"LastUpdateDate": "07/18/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHEELER",
"AuthorizedOfficialFirstName": "NICHOLAS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
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"AuthorizedOfficialCredential": "BOCP, LP",
"AuthorizedOfficialTelephoneNumber": "606-585-4996",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}