{
"Npi": {
"NPI": "1417255621",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CAREFREE PAIN CLINIC 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": "PO BOX 232",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CAVE CREEK",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85327-0232",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "480-488-1282",
"MailingAddressFaxNumber": "480-488-9040",
"FirstLinePracticeLocationAddress": "7208 E. CAVE CREEK RD.",
"SecondLinePracticeLocationAddress": "SUITE F",
"PracticeLocationAddressCityName": "CAREFREE",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85377",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "480-488-1282",
"PracticeLocationAddressFaxNumber": "480-488-9040",
"EnumerationDate": "03/11/2011",
"LastUpdateDate": "03/11/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OLTJENBRUNS",
"AuthorizedOfficialFirstName": "JURGEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "480-488-1282",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "OTC4954",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}