{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "GENOA HEALTHCARE CLINICAL LABORATORY LLC",
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"Credential": null,
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"FirstLineMailingAddress": "18300 CASCADE AVE S",
"SecondLineMailingAddress": "SUITE 251",
"MailingAddressCityName": "TUKWILA",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98188-4746",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "425-679-5692",
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"FirstLinePracticeLocationAddress": "3101 OLD HIGHWAY 8",
"SecondLinePracticeLocationAddress": "SUITE 203-A",
"PracticeLocationAddressCityName": "ROSEVILLE",
"PracticeLocationAddressStateName": "MN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "952-388-0400",
"PracticeLocationAddressFaxNumber": "651-304-1902",
"EnumerationDate": "01/05/2011",
"LastUpdateDate": "07/22/2011",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STROETZ",
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"AuthorizedOfficialCredential": "MT ASCP",
"AuthorizedOfficialTelephoneNumber": "651-917-4029",
"Taxonomies": {
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"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}