{
"Npi": {
"NPI": "1407390446",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FIRST CHOICE MAITLAND, PLLC",
"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": "1945 WEST COUNTY ROAD 419",
"SecondLineMailingAddress": "SUITE 1101",
"MailingAddressCityName": "OVIEDO",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32766",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-366-2890",
"MailingAddressFaxNumber": "407-366-2843",
"FirstLinePracticeLocationAddress": "110 NORTH ORLANDO AVENUE",
"SecondLinePracticeLocationAddress": "SUITE 14",
"PracticeLocationAddressCityName": "MAITLAND",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32751",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-335-4045",
"PracticeLocationAddressFaxNumber": "407-335-4279",
"EnumerationDate": "12/09/2016",
"LastUpdateDate": "12/09/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARBOUR",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "407-366-2890",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}