{
"Npi": {
"NPI": "1558559070",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TRINITY MEDICAL MANAGEMENT LLC",
"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": "1702 S DIXIE HWY",
"SecondLineMailingAddress": "STE 2",
"MailingAddressCityName": "LAKE WORTH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33460-5886",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-588-0199",
"MailingAddressFaxNumber": "561-588-0215",
"FirstLinePracticeLocationAddress": "1702 S DIXIE HWY",
"SecondLinePracticeLocationAddress": "STE 2",
"PracticeLocationAddressCityName": "LAKE WORTH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33460-5886",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-588-0199",
"PracticeLocationAddressFaxNumber": "561-588-0215",
"EnumerationDate": "10/10/2007",
"LastUpdateDate": "06/21/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DELEON",
"AuthorizedOfficialFirstName": "EVELYN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "561-588-0199",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302R00000X",
"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "ME86283",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}