{
"Npi": {
"NPI": "1619204203",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "PIONEER MEDICAL, IDTF",
"ParentOrgTIN": null,
"OrgName": "PIONEER MEDICAL PORTABLE XRAY,LLC",
"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": "100 CLARENDON AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PETAL",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39465-2636",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-550-4611",
"MailingAddressFaxNumber": "601-510-9449",
"FirstLinePracticeLocationAddress": "100 CLARENDON AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PETAL",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39465-2636",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-550-4611",
"PracticeLocationAddressFaxNumber": "601-510-9449",
"EnumerationDate": "11/03/2009",
"LastUpdateDate": "11/10/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CRABTREE",
"AuthorizedOfficialFirstName": "TED",
"AuthorizedOfficialMiddleName": "H",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "RT",
"AuthorizedOfficialTelephoneNumber": "601-550-4611",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335V00000X",
"TaxonomyName": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}