{
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"IsOrgSubpart": "N",
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"OrgName": "GENESYS INTEGRATED GROUP PRACTICE PC",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
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"FirstLineMailingAddress": "3495 S CENTER RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BURTON",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48519-1455",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "810-424-2007",
"MailingAddressFaxNumber": "810-743-1099",
"FirstLinePracticeLocationAddress": "4154 W VIENNA RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CLIO",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48420-9402",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "810-686-7397",
"PracticeLocationAddressFaxNumber": "810-686-3756",
"EnumerationDate": "04/20/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GARSON",
"AuthorizedOfficialFirstName": "PAUL",
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"AuthorizedOfficialTitle": "CHIEF FINANCIAL OFFICER",
"AuthorizedOfficialNamePrefix": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "810-424-2007",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}