{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "THE FOOT AND ANKLE WELLNESS CENTER OF WESTERN PENNSYLVANIA, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "313 FORD ST",
"SecondLineMailingAddress": "SUITE 3B",
"MailingAddressCityName": "FORD CITY",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "16226-1268",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "724-763-4080",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "313 FORD ST",
"SecondLinePracticeLocationAddress": "SUITE 3B",
"PracticeLocationAddressCityName": "FORD CITY",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "16226-1268",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "724-763-4080",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/02/2007",
"LastUpdateDate": "02/16/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SABO",
"AuthorizedOfficialFirstName": "MATTHEW",
"AuthorizedOfficialMiddleName": "JAMES",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "724-445-3053",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "SC-004742-L",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}