{
"Npi": {
"NPI": "1497068027",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SONOLAB IMAGING SOLUTIONS, 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 1123",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN BENITO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78586-0012",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "956-792-0755",
"MailingAddressFaxNumber": "956-440-8484",
"FirstLinePracticeLocationAddress": "808 W ARROYO PARK LN APT D",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HARLINGEN",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78550-8462",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "956-792-0755",
"PracticeLocationAddressFaxNumber": "956-440-8484",
"EnumerationDate": "07/25/2010",
"LastUpdateDate": "07/25/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MATEO",
"AuthorizedOfficialFirstName": "FREDDIE",
"AuthorizedOfficialMiddleName": "DANIEL",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "RDMS, RVT, RT(R)",
"AuthorizedOfficialTelephoneNumber": "956-792-0755",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0208X",
"TaxonomyName": "Mobile Radiology Clinic/Center",
"LicenseNumber": "80226",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}