{
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "2700 SHELL RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GEORGETOWN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78628-9237",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "512-688-5607",
"MailingAddressFaxNumber": "512-436-0802",
"FirstLinePracticeLocationAddress": "2700 SHELL RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GEORGETOWN",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "512-688-5607",
"PracticeLocationAddressFaxNumber": "512-436-0802",
"EnumerationDate": "04/18/2017",
"LastUpdateDate": "06/01/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BARTELL",
"AuthorizedOfficialFirstName": "BEEBEE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "512-688-5607",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community Based Hospice Care Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}