{
"Npi": {
"NPI": "1457897167",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "MIDWEST WELLNESS INSTITUTE LLC",
"ParentOrgTIN": null,
"OrgName": "MIDWEST TMS 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": "1309 OAK AVE STE 207",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WACONIA",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55387-1080",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "952-442-3828",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1309 OAK AVE STE 207",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WACONIA",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55387-1080",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "952-442-3828",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/19/2017",
"LastUpdateDate": "01/19/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PAVLIS",
"AuthorizedOfficialFirstName": "CLAY",
"AuthorizedOfficialMiddleName": "JOSEPH",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "605-864-1795",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": "47358",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}