{
"Npi": {
"NPI": "1386832368",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LIFESCAN TENNESSEE, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "701 N STATE OF FRANKLIN RD",
"SecondLineMailingAddress": "SUITE 1",
"MailingAddressCityName": "JOHNSON CITY",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37604-3645",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "423-477-3026",
"MailingAddressFaxNumber": "423-477-2686",
"FirstLinePracticeLocationAddress": "830 SUNCREST DR",
"SecondLinePracticeLocationAddress": "UNIT 2",
"PracticeLocationAddressCityName": "GRAY",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37615-3424",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "423-477-3026",
"PracticeLocationAddressFaxNumber": "423-477-2686",
"EnumerationDate": "10/04/2007",
"LastUpdateDate": "09/20/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GREGORY",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "423-477-3026",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0200X",
"TaxonomyName": "Radiology Clinic/Center",
"LicenseNumber": "ODC0000000042",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}