{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTH CENTRAL MEDICAL SERVICES, P.A.",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "PO BOX 11020",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT SMITH",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72917-1020",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "479-434-4887",
"MailingAddressFaxNumber": "479-434-4955",
"FirstLinePracticeLocationAddress": "600 AUTUMN RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LITTLE ROCK",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72211-3606",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "501-448-2342",
"PracticeLocationAddressFaxNumber": "501-221-0615",
"EnumerationDate": "06/09/2014",
"LastUpdateDate": "06/09/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARLSON",
"AuthorizedOfficialFirstName": "CHESTER",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "OWNER/MEDICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "479-657-6888",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208D00000X",
"TaxonomyName": "General Practice Physician",
"LicenseNumber": "E5307",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}