{
"Npi": {
"NPI": "1467601765",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COLLEGE DRIVE URGENT CARE 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": "2145 E BASELINE RD STE 303",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TEMPE",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85283-1515",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-705-8558",
"MailingAddressFaxNumber": "480-776-0025",
"FirstLinePracticeLocationAddress": "2030 BLUEGRASS CIR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHEYENNE",
"PracticeLocationAddressStateName": "WY",
"PracticeLocationAddressPostalCode": "82009-7328",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "307-635-3500",
"PracticeLocationAddressFaxNumber": "307-635-2199",
"EnumerationDate": "09/11/2008",
"LastUpdateDate": "04/29/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KANE",
"AuthorizedOfficialFirstName": "CHRIS",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "AUTHORIZED OFFICIAL",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "888-705-8558",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}