{
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"OrgName": "NORTHEAST BAPTIST SURGERY CENTER LLC",
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"FirstLineMailingAddress": "8715 VILLAGE DR",
"SecondLineMailingAddress": "SUITE 200",
"MailingAddressCityName": "SAN ANTONIO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78217",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "210-477-1775",
"MailingAddressFaxNumber": "210-477-1794",
"FirstLinePracticeLocationAddress": "8715 VILLAGE DR",
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"PracticeLocationAddressCityName": "SAN ANTONIO",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "210-477-1775",
"PracticeLocationAddressFaxNumber": "210-477-1794",
"EnumerationDate": "07/01/2005",
"LastUpdateDate": "11/05/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WALTON",
"AuthorizedOfficialFirstName": "MISTY",
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"AuthorizedOfficialTelephoneNumber": "210-477-1788",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "000369",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}