{
"Npi": {
"NPI": "1609697457",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EAST TEXAS HEMATOLOGY & ONCOLOGY",
"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": "1202 W FRANK AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LUFKIN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75904-3304",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "936-637-6415",
"MailingAddressFaxNumber": "346-226-3524",
"FirstLinePracticeLocationAddress": "1202 W FRANK AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LUFKIN",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75904-3304",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "936-637-6415",
"PracticeLocationAddressFaxNumber": "346-226-3524",
"EnumerationDate": "10/23/2024",
"LastUpdateDate": "10/23/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PINNAMANENI",
"AuthorizedOfficialFirstName": "PRAMOD",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHYSICIAN",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD, MBA",
"AuthorizedOfficialTelephoneNumber": "936-637-6415",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3336S0011X",
"TaxonomyName": "Specialty Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}