{
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"ParentOrgLBN": null,
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "PO BOX 2067",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JOPLIN",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "64804-2067",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "417-624-2111",
"MailingAddressFaxNumber": "417-624-1551",
"FirstLinePracticeLocationAddress": "1905 W32ND STREET",
"SecondLinePracticeLocationAddress": "SUITE 306",
"PracticeLocationAddressCityName": "JOPLIN",
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"PracticeLocationAddressTelephoneNumber": "417-624-2111",
"PracticeLocationAddressFaxNumber": "417-624-1551",
"EnumerationDate": "05/11/2010",
"LastUpdateDate": "02/17/2012",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LACEY",
"AuthorizedOfficialFirstName": "HUGH",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "417-624-2111",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207V00000X",
"TaxonomyName": "Obstetrics & Gynecology Physician",
"LicenseNumber": "R6N85",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}