{
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SHENANDOAH MEDICAL SUPPLY, INC.",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 357",
"SecondLineMailingAddress": "36 LUCAS RD",
"MailingAddressCityName": "FISHERSVILLE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22939-0357",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "540-337-0072",
"MailingAddressFaxNumber": "540-337-0076",
"FirstLinePracticeLocationAddress": "36 LUCAS RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FISHERSVILLE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22939-2335",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "540-337-0072",
"PracticeLocationAddressFaxNumber": "540-337-0076",
"EnumerationDate": "05/15/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TOMAN",
"AuthorizedOfficialFirstName": "EDWARD",
"AuthorizedOfficialMiddleName": "LEE",
"AuthorizedOfficialTitle": "OPERATIONS MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "540-337-0072",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "0002426676",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}