{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
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"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1327 SUPERIOR ST",
"SecondLineMailingAddress": "SUITE 111",
"MailingAddressCityName": "SANDPOINT",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83864-1735",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-501-8895",
"MailingAddressFaxNumber": "208-965-8128",
"FirstLinePracticeLocationAddress": "1327 SUPERIOR ST",
"SecondLinePracticeLocationAddress": "SUITE 111",
"PracticeLocationAddressCityName": "SANDPOINT",
"PracticeLocationAddressStateName": "ID",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-501-8895",
"PracticeLocationAddressFaxNumber": "208-965-8128",
"EnumerationDate": "10/07/2014",
"LastUpdateDate": "10/07/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ISPIRESCU",
"AuthorizedOfficialFirstName": "JEFFREY",
"AuthorizedOfficialMiddleName": "S",
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"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "208-263-9757",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "W137644",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}