{
"Npi": {
"NPI": "1477602100",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROFESSIONAL HEALTHCARE SERVICES, 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": "PO BOX 722",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GROVER",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63040-0722",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "636-458-4405",
"MailingAddressFaxNumber": "636-458-4409",
"FirstLinePracticeLocationAddress": "16341 CENTERPOINTE DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GROVER",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63040-1602",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "636-458-4405",
"PracticeLocationAddressFaxNumber": "636-458-4409",
"EnumerationDate": "01/10/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SPERR",
"AuthorizedOfficialFirstName": "WESLEY",
"AuthorizedOfficialMiddleName": "PAUL",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "636-458-4405",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}