{
"Npi": {
"NPI": "1508593997",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "STRIDE PROSTHETICS LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 611",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FLATWOODS",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "41139-0611",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "606-836-5347",
"MailingAddressFaxNumber": "888-508-6271",
"FirstLinePracticeLocationAddress": "905 BELLEFONTE RD STE B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FLATWOODS",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "41139-2005",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "606-836-5347",
"PracticeLocationAddressFaxNumber": "888-508-6271",
"EnumerationDate": "08/04/2022",
"LastUpdateDate": "10/25/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHEELER",
"AuthorizedOfficialFirstName": "NICHOLAS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "719-581-7399",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}