{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"LastName": null,
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"NamePrefix": null,
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"Credential": null,
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"FirstLineMailingAddress": "PO BOX 152",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LACONIA",
"MailingAddressStateName": "NH",
"MailingAddressPostalCode": "03247-0152",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "603-542-6337",
"MailingAddressFaxNumber": "603-287-7139",
"FirstLinePracticeLocationAddress": "109 PLEASANT ST",
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"PracticeLocationAddressCityName": "CLAREMONT",
"PracticeLocationAddressStateName": "NH",
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"PracticeLocationAddressTelephoneNumber": "603-542-6337",
"PracticeLocationAddressFaxNumber": "603-287-7139",
"EnumerationDate": "09/29/2016",
"LastUpdateDate": "08/29/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BEANE",
"AuthorizedOfficialFirstName": "CHAD",
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"AuthorizedOfficialTitle": "MEMBER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "603-542-6337",
"Taxonomies": {
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{
"TaxonomyCode": "333600000X",
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"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}