{
"Npi": {
"NPI": "1619268810",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PATRICK E IGBOKWE",
"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": "209 KENDRA DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VICKSBURG",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39180-8986",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-630-9300",
"MailingAddressFaxNumber": "601-630-0133",
"FirstLinePracticeLocationAddress": "4798 HIGHWAY 61 S",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "VICKSBURG",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39180-7125",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-630-9300",
"PracticeLocationAddressFaxNumber": "601-630-0133",
"EnumerationDate": "04/22/2011",
"LastUpdateDate": "06/27/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IGBOKWE",
"AuthorizedOfficialFirstName": "PATRICK",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "OWNER/SOLE MEMBER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "601-636-3692",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "07659/11.1",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}