{
"Npi": {
"NPI": "1447485958",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ERNST PSYCHIATRIC SERVICES, 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": "P.O. BOX 154",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRISTOL",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37621-0154",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "423-990-2100",
"MailingAddressFaxNumber": "423-652-2884",
"FirstLinePracticeLocationAddress": "100 5TH ST STE 340",
"SecondLinePracticeLocationAddress": "SHELBY SQUARE",
"PracticeLocationAddressCityName": "BRISTOL",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37620-5919",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "423-990-2100",
"PracticeLocationAddressFaxNumber": "423-652-2884",
"EnumerationDate": "05/28/2009",
"LastUpdateDate": "02/25/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ERNST",
"AuthorizedOfficialFirstName": "MARY",
"AuthorizedOfficialMiddleName": "PAT",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "APRN, BC",
"AuthorizedOfficialTelephoneNumber": "423-990-2100",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1041C0700X",
"TaxonomyName": "Clinical Social Worker",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}