{
"Npi": {
"NPI": "1609323708",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CARRIE B. BOYD HEALTHCARE CENTER",
"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": "PO BOX 7140",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FISHERS",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46038-7140",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "317-501-0210",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5555 N TACOMA AVE",
"SecondLinePracticeLocationAddress": "12",
"PracticeLocationAddressCityName": "INDIANAPOLIS",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "46220-3512",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "317-501-0210",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/06/2016",
"LastUpdateDate": "09/06/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CORK",
"AuthorizedOfficialFirstName": "CARLA",
"AuthorizedOfficialMiddleName": "V",
"AuthorizedOfficialTitle": "PHYSICIAN/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O., M.A.T.",
"AuthorizedOfficialTelephoneNumber": "317-501-0210",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": "02003708A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}