{
"Npi": {
"NPI": "1437575057",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LARAMIE HEARING AID 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": "204 MCCOLLUM ST STE 107",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LARAMIE",
"MailingAddressStateName": "WY",
"MailingAddressPostalCode": "82070-5151",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "307-742-4327",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "204 MCCOLLUM ST STE 107",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LARAMIE",
"PracticeLocationAddressStateName": "WY",
"PracticeLocationAddressPostalCode": "82070-5151",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "307-742-4327",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/06/2014",
"LastUpdateDate": "03/06/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEVIN",
"AuthorizedOfficialFirstName": "LISA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/HEARING AID SPECIALIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "307-742-4327",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332S00000X",
"TaxonomyName": "Hearing Aid Equipment",
"LicenseNumber": "175",
"LicenseNumberStateCode": "WY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}