{
"Npi": {
"NPI": "1497930630",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ETHEL SHADE DBA SURE SHOT X-RAY MOBILE X-RAY SERVICES",
"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": "7310 S WESTMORELAND RD STE 11",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DALLAS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75237-3015",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-822-9292",
"MailingAddressFaxNumber": "972-298-1137",
"FirstLinePracticeLocationAddress": "7310 S WESTMORELAND RD STE 11",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DALLAS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75237-3015",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-822-9292",
"PracticeLocationAddressFaxNumber": "972-298-1137",
"EnumerationDate": "01/07/2008",
"LastUpdateDate": "12/15/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHADE",
"AuthorizedOfficialFirstName": "ETHEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RT",
"AuthorizedOfficialTelephoneNumber": "972-822-9292",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0208X",
"TaxonomyName": "Mobile Radiology Clinic/Center",
"LicenseNumber": "R31722",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}