{
"Npi": {
"NPI": "1437330388",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MARION AREA NEUROLOGICAL CONSULTING",
"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": "1728 MARION WALDO RD",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "MARION",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43302-7457",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "740-725-8300",
"MailingAddressFaxNumber": "740-725-1213",
"FirstLinePracticeLocationAddress": "1728 MARION WALDO RD",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "MARION",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43302-7457",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "740-725-8300",
"PracticeLocationAddressFaxNumber": "740-725-1213",
"EnumerationDate": "11/20/2007",
"LastUpdateDate": "10/31/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KELLUM",
"AuthorizedOfficialFirstName": "JESSE",
"AuthorizedOfficialMiddleName": "B.",
"AuthorizedOfficialTitle": "M.D. OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "740-725-8300",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "35051174K",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}