{
"Npi": {
"NPI": "1457480683",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WOLF RIVER FAMILY FOOTCARE PLLC",
"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": "7424 US HIGHWAY 64",
"SecondLineMailingAddress": "SUITE 119",
"MailingAddressCityName": "BARTLETT",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38133-3986",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "901-381-2800",
"MailingAddressFaxNumber": "901-381-2677",
"FirstLinePracticeLocationAddress": "7424 US HIGHWAY 64",
"SecondLinePracticeLocationAddress": "SUITE 119",
"PracticeLocationAddressCityName": "BARTLETT",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "38133-3986",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "901-381-2800",
"PracticeLocationAddressFaxNumber": "901-381-2677",
"EnumerationDate": "03/05/2007",
"LastUpdateDate": "06/05/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SICILIANO",
"AuthorizedOfficialFirstName": "CARL",
"AuthorizedOfficialMiddleName": "JOSEPH",
"AuthorizedOfficialTitle": "OWNER SOLE MEMBER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.P.M.",
"AuthorizedOfficialTelephoneNumber": "901-381-2800",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "DPM0000000422",
"LicenseNumberStateCode": "TN",
"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."
}
}
}
}