{
"Npi": {
"NPI": "1558683953",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BLACK MOUNTAIN NEURO-MEDICAL TREATMENT CENTER",
"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": "932 OLD US 70 W",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BLACK MOUNTAIN",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28711-2547",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "828-259-6720",
"MailingAddressFaxNumber": "828-669-3169",
"FirstLinePracticeLocationAddress": "932 OLD US 70 W",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BLACK MOUNTAIN",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28711-2547",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "828-259-6720",
"PracticeLocationAddressFaxNumber": "828-669-3169",
"EnumerationDate": "02/26/2010",
"LastUpdateDate": "03/07/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ST CLAIR",
"AuthorizedOfficialFirstName": "JACK",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "BUSINESS MANAGER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "ED. D.",
"AuthorizedOfficialTelephoneNumber": "828-259-6720",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "N/A",
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}