{
"Npi": {
"NPI": "1508437385",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "SPEEDWAY SURGICAL SPECIALISTS, LLC",
"ParentOrgTIN": null,
"OrgName": "SPEEDWAY SURGICAL SPECIALISTS, 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": "6442 E SPEEDWAY BLVD STE 152",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TUCSON",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85710-0013",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "520-771-8175",
"MailingAddressFaxNumber": "520-771-9194",
"FirstLinePracticeLocationAddress": "6442 E SPEEDWAY BLVD STE 152",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TUCSON",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85710-1134",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "520-771-8175",
"PracticeLocationAddressFaxNumber": "520-771-9402",
"EnumerationDate": "07/02/2021",
"LastUpdateDate": "05/10/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NAMANNY",
"AuthorizedOfficialFirstName": "AMY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "BOARD MEMBER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD/MBA",
"AuthorizedOfficialTelephoneNumber": "520-777-4090",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}