{
"Npi": {
"NPI": "1609102524",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PSALM CLINICAL LABORATORY AND HOMECARE OF AMERICA INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5801 TAMARACK BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLUMBUS",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43229-3747",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "614-524-0441",
"MailingAddressFaxNumber": "614-524-0441",
"FirstLinePracticeLocationAddress": "5801 TAMARACK BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COLUMBUS",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43229-3747",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "614-524-0441",
"PracticeLocationAddressFaxNumber": "614-524-0441",
"EnumerationDate": "10/28/2009",
"LastUpdateDate": "10/28/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ILEABOYA",
"AuthorizedOfficialFirstName": "FRIDAY",
"AuthorizedOfficialMiddleName": "SAMUEL",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MBA /MLT(ASCP)",
"AuthorizedOfficialTelephoneNumber": "614-524-0441",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": null,
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}