{
"Npi": {
"NPI": "1619088531",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PHYSICIANS HOSPICE, 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": "PO BOX 387",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MARKS",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "38646-0387",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "662-326-7323",
"MailingAddressFaxNumber": "662-326-6348",
"FirstLinePracticeLocationAddress": "340 GETWELL ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MARKS",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "38646-9785",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "662-326-7323",
"PracticeLocationAddressFaxNumber": "662-326-6348",
"EnumerationDate": "08/31/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WALLER",
"AuthorizedOfficialFirstName": "RICHARD",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "662-326-3500",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251G00000X",
"TaxonomyName": "Community Based Hospice Care Agency",
"LicenseNumber": "055",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}