{
"Npi": {
"NPI": "1356326409",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VISTA CLINICAL DIAGNOSTICS 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": "4290 S HWY 27",
"SecondLineMailingAddress": "SUITE 201",
"MailingAddressCityName": "CLERMONT",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34711-8066",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-536-9270",
"MailingAddressFaxNumber": "352-536-9279",
"FirstLinePracticeLocationAddress": "4290 S HWY 27",
"SecondLinePracticeLocationAddress": "SUITE 201",
"PracticeLocationAddressCityName": "CLERMONT",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34711-8066",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "352-536-9270",
"PracticeLocationAddressFaxNumber": "352-536-9279",
"EnumerationDate": "12/13/2005",
"LastUpdateDate": "06/13/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SANTANA",
"AuthorizedOfficialFirstName": "DAVIAN",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "352-536-9270",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": "800027066",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}