{
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"OrgName": "FOREVER INK",
"LastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3257 ROBINS TRCE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AKRON",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44319-3885",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3257 ROBINS TRCE",
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"PracticeLocationAddressCityName": "AKRON",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/17/2015",
"LastUpdateDate": "01/17/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GEORGE",
"AuthorizedOfficialFirstName": "DENISE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "SPECIALIST",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "330-283-4645",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "1538557970",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}