{
"Npi": {
"NPI": "1609060383",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SHRADER FAMILY MEDICAL CLINIC, PA",
"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": "429 N. GUN BARREL LANE",
"SecondLineMailingAddress": "SUITE 111",
"MailingAddressCityName": "GUN BARREL CITY",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75156",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "903-887-2704",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "429 N GUN BARREL LN",
"SecondLinePracticeLocationAddress": "SUITE 111",
"PracticeLocationAddressCityName": "GUN BARREL CITY",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75156-3731",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "903-887-2704",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/05/2007",
"LastUpdateDate": "09/05/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHRADER",
"AuthorizedOfficialFirstName": "KAREN",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "903-887-2704",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "G3787",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}