{
"Npi": {
"NPI": "1578456224",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DAKOTA DIAGNOSTICS 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": "250 NW MAIN BLVD STE 12",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKE CITY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32055-3380",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "866-332-5682",
"MailingAddressFaxNumber": "866-332-5682",
"FirstLinePracticeLocationAddress": "226 S MARION AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAKE CITY",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32025-7058",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "866-332-5682",
"PracticeLocationAddressFaxNumber": "866-332-5682",
"EnumerationDate": "06/02/2025",
"LastUpdateDate": "09/04/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JACKSON",
"AuthorizedOfficialFirstName": "TA'SHEIKA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CMA, CPT, MT, IV TEC",
"AuthorizedOfficialTelephoneNumber": "866-332-5682",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "246RP1900X",
"TaxonomyName": "Phlebotomy Technician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}