{
"Npi": {
"NPI": "1588282842",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MICHIANA MEDICAL SUPPLY 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": "1509 W JOHN BEERS RD STE A&B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STEVENSVILLE",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "49127-9408",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "269-932-4765",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1509 W JOHN BEERS RD STE A&B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STEVENSVILLE",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "49127-9408",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "269-932-4765",
"PracticeLocationAddressFaxNumber": "269-621-6110",
"EnumerationDate": "07/13/2020",
"LastUpdateDate": "05/14/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BROWER",
"AuthorizedOfficialFirstName": "KARMEN",
"AuthorizedOfficialMiddleName": "ANN",
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "269-313-2370",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}