{
"Npi": {
"NPI": "1558536938",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CLINICA CAMPESINA FAMILY HEALTH SERVICES",
"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": "1735 S PUBLIC RD STE 203",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAFAYETTE",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80026-7093",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "303-665-9310",
"MailingAddressFaxNumber": "303-328-2691",
"FirstLinePracticeLocationAddress": "1735 S PUBLIC RD # 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAFAYETTE",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80026-7093",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "303-665-9310",
"PracticeLocationAddressFaxNumber": "303-328-2691",
"EnumerationDate": "04/25/2008",
"LastUpdateDate": "01/28/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SMITH",
"AuthorizedOfficialFirstName": "SIMON",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "303-665-2962",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0002X",
"TaxonomyName": "Clinic Pharmacy",
"LicenseNumber": "322",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}