{
"Npi": {
"NPI": "1619383650",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PEDIATRIC AND ADULT RECONSTRUCTIVE CENTER FOR UROLOGY, PLLC",
"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": "3716 STANDBRIDGE DRIVE # 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "THE COLONY",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75056",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "214-618-4405",
"MailingAddressFaxNumber": "214-618-5506",
"FirstLinePracticeLocationAddress": "3716 STANDBRIDGE DRIVE # 200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "THE COLONY",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75056",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "214-618-4405",
"PracticeLocationAddressFaxNumber": "214-618-5506",
"EnumerationDate": "07/10/2014",
"LastUpdateDate": "08/09/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SNODGRASS",
"AuthorizedOfficialFirstName": "WARREN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "214-618-4405",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2088P0231X",
"TaxonomyName": "Pediatric Urology Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208800000X",
"TaxonomyName": "Urology Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}