{
"Npi": {
"NPI": "1548446099",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MORGANTOWN PLASTIC SURGERY ASSOCIATES",
"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": "5000 COOMBS FARM DR",
"SecondLineMailingAddress": "STE 102",
"MailingAddressCityName": "MORGANTOWN",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "26508-1121",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-777-4677",
"MailingAddressFaxNumber": "304-777-4679",
"FirstLinePracticeLocationAddress": "5000 COOMBS FARM DR",
"SecondLinePracticeLocationAddress": "STE 102",
"PracticeLocationAddressCityName": "MORGANTOWN",
"PracticeLocationAddressStateName": "WV",
"PracticeLocationAddressPostalCode": "26508-1121",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-777-4677",
"PracticeLocationAddressFaxNumber": "304-777-4679",
"EnumerationDate": "01/15/2008",
"LastUpdateDate": "04/22/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MILLER",
"AuthorizedOfficialFirstName": "BECKY",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRACTICE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "304-777-4677",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208200000X",
"TaxonomyName": "Plastic Surgery Physician",
"LicenseNumber": "21436",
"LicenseNumberStateCode": "WV",
"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."
}
}
}
}