{
"Npi": {
"NPI": "1609896216",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SALT LAKE ENDOSCOPY 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": "24 SOUTH 1100 EAST #103",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SALT LAKE CITY",
"MailingAddressStateName": "UT",
"MailingAddressPostalCode": "84102",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "801-355-2987",
"MailingAddressFaxNumber": "801-531-9704",
"FirstLinePracticeLocationAddress": "24 S 1100 E STE 103",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SALT LAKE CITY",
"PracticeLocationAddressStateName": "UT",
"PracticeLocationAddressPostalCode": "84102-1592",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "801-355-2987",
"PracticeLocationAddressFaxNumber": "801-531-9704",
"EnumerationDate": "07/20/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ELLINGTON",
"AuthorizedOfficialFirstName": "STEWART",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DR",
"AuthorizedOfficialTelephoneNumber": "801-364-5767",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "2006-ASF-332",
"LicenseNumberStateCode": "UT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}