{
"Npi": {
"NPI": "1629313739",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COLTON CA MULTI ASC LP",
"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": "1A BURTON HILLS BLVD.",
"SecondLineMailingAddress": "LICENSURE AND CERT DEPT",
"MailingAddressCityName": "NASHVILLE",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37215-6187",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "615-263-4011",
"MailingAddressFaxNumber": "615-234-1720",
"FirstLinePracticeLocationAddress": "1003 E BRIER DRIVE",
"SecondLinePracticeLocationAddress": "SUITE 170",
"PracticeLocationAddressCityName": "SAN BERNARDINO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92408-2862",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-370-2190",
"PracticeLocationAddressFaxNumber": "909-370-2266",
"EnumerationDate": "11/29/2012",
"LastUpdateDate": "01/20/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SNODGRASS",
"AuthorizedOfficialFirstName": "JEFFERY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "615-665-1283",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}