{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "RUSSELL C. SPOTTS",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "506 2ND ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "IDA GROVE",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "51445-1305",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "712-364-2734",
"MailingAddressFaxNumber": "712-364-3068",
"FirstLinePracticeLocationAddress": "506 2ND ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "IDA GROVE",
"PracticeLocationAddressStateName": "IA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "712-364-2734",
"PracticeLocationAddressFaxNumber": "712-364-3068",
"EnumerationDate": "03/29/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SPOTTS",
"AuthorizedOfficialFirstName": "RUSSELL",
"AuthorizedOfficialMiddleName": "CLINTON",
"AuthorizedOfficialTitle": "PHARMACIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "712-364-2734",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "768",
"LicenseNumberStateCode": "IA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}