{
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"EIN": null,
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"FirstLineMailingAddress": "410 E HIGH ST STE A",
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"MailingAddressCityName": "POTOSI",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63664-1927",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "573-438-2349",
"MailingAddressFaxNumber": "573-438-8877",
"FirstLinePracticeLocationAddress": "410 E HIGH ST STE A",
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"PracticeLocationAddressCityName": "POTOSI",
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"PracticeLocationAddressFaxNumber": "573-438-8877",
"EnumerationDate": "09/06/2006",
"LastUpdateDate": "01/04/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "THOMPSON",
"AuthorizedOfficialFirstName": "KELLIE",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "573-768-1529",
"Taxonomies": {
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{
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"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
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}
]
},
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}
}