{
"Npi": {
"NPI": "1457951923",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LOGOS CLINICAL LABORATORY LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7920 BELT LINE RD STE 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DALLAS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75254-8653",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "903-456-5358",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7920 BELT LINE RD STE 200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DALLAS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75254-8653",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "903-456-5358",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/26/2020",
"LastUpdateDate": "04/27/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KANE",
"AuthorizedOfficialFirstName": "PETER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "903-787-1451",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}