{
"Npi": {
"NPI": "1558545210",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MAGNOLIA MANOR OF TUPELO",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1514 COUNTY ROAD 41",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TUPELO",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "38801-0681",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "662-842-6776",
"MailingAddressFaxNumber": "662-842-6512",
"FirstLinePracticeLocationAddress": "1514 COUNTY ROAD 41",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TUPELO",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "38801-0681",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "662-842-6776",
"PracticeLocationAddressFaxNumber": "662-842-6512",
"EnumerationDate": "12/18/2007",
"LastUpdateDate": "12/18/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PHARR",
"AuthorizedOfficialFirstName": "DONNA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "662-842-6776",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "305R00000X",
"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": "1000",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}