{
"Npi": {
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VEIN CLINIC PA",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "470 W 78TH ST",
"SecondLineMailingAddress": "STE. 250",
"MailingAddressCityName": "CHANHASSEN",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55317-4524",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "952-934-3296",
"MailingAddressFaxNumber": "952-906-1737",
"FirstLinePracticeLocationAddress": "16372 KENRICK AVE",
"SecondLinePracticeLocationAddress": "SUITE 100",
"PracticeLocationAddressCityName": "LAKEVILLE",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55044-3540",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "952-892-1222",
"PracticeLocationAddressFaxNumber": "952-892-1221",
"EnumerationDate": "08/24/2010",
"LastUpdateDate": "01/02/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GUPTA",
"AuthorizedOfficialFirstName": "SAMEER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO/PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "952-934-3296",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}