{
"Npi": {
"NPI": "1396828323",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EYE CARE SURGERY CENTER OF MEMPHIS, LLC",
"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": "825 RIDGE LAKE BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MEMPHIS",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38120-9411",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "901-685-2200",
"MailingAddressFaxNumber": "901-255-5631",
"FirstLinePracticeLocationAddress": "5350 POPLAR AVE",
"SecondLinePracticeLocationAddress": "SUITE 900",
"PracticeLocationAddressCityName": "MEMPHIS",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "38119-3699",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "901-473-8115",
"PracticeLocationAddressFaxNumber": "901-473-8116",
"EnumerationDate": "10/23/2006",
"LastUpdateDate": "07/25/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOLLAMUDI",
"AuthorizedOfficialFirstName": "SUBBA",
"AuthorizedOfficialMiddleName": "R.",
"AuthorizedOfficialTitle": "CHAIRMAN AND MANAGER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "901-685-2200",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "0000000167",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}