{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "HAIR SPECIALTY SUPPLY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5707 CIBOLO CANYON BLVD",
"SecondLineMailingAddress": "1617",
"MailingAddressCityName": "SAN ANTONIO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78261-2773",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "210-367-3800",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5707 CIBOLO CANYON BLVD",
"SecondLinePracticeLocationAddress": "1617",
"PracticeLocationAddressCityName": "SAN ANTONIO",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "210-367-3800",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/07/2007",
"LastUpdateDate": "07/04/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HAMILTON",
"AuthorizedOfficialFirstName": "LELA",
"AuthorizedOfficialMiddleName": "Z",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MISS",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "210-367-3800",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": "1011437",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}