{
"Npi": {
"NPI": "1629259429",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GUARDIAN ANGEL FOOT CARE OF BRADENTON VENICE AND ENGLEWOOD INC",
"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": "2400 S MCCALL RD STE F",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ENGLEWOOD",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34224-5136",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "941-473-3338",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2400 S MCCALL RD STE F",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ENGLEWOOD",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34224-5136",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "941-473-3338",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/20/2007",
"LastUpdateDate": "04/22/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LANE",
"AuthorizedOfficialFirstName": "HERBERT",
"AuthorizedOfficialMiddleName": "T",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "941-473-3338",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP1100X",
"TaxonomyName": "Podiatric Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}