{
"Npi": {
"NPI": "1356559959",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MED-CARE CONVALESCENT SUPPLY CO. INC",
"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": "109 AVONDALE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DAYTON",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45404-2123",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "937-236-0527",
"MailingAddressFaxNumber": "937-237-9192",
"FirstLinePracticeLocationAddress": "109 AVONDALE DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DAYTON",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45404-2123",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "937-236-0527",
"PracticeLocationAddressFaxNumber": "937-237-9192",
"EnumerationDate": "05/18/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOPWOOD",
"AuthorizedOfficialFirstName": "WILLLIAM",
"AuthorizedOfficialMiddleName": "T",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OWNER",
"AuthorizedOfficialTelephoneNumber": "937-236-0527",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332BP3500X",
"TaxonomyName": "Parenteral & Enteral Nutrition Supplies (DME)",
"LicenseNumber": "57-154864",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}