{
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"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
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"FirstLineMailingAddress": "527 KEISLER DR STE 104",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CARY",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27518-9306",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "919-747-9336",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1638 OWEN DR RM 0-004",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FAYETTEVILLE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28304-3424",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "919-747-9336",
"PracticeLocationAddressFaxNumber": "984-200-7575",
"EnumerationDate": "02/28/2024",
"LastUpdateDate": "02/28/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CROMITY",
"AuthorizedOfficialFirstName": "JACQUELINE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CFM",
"AuthorizedOfficialTelephoneNumber": "919-747-9336",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332BC3200X",
"TaxonomyName": "Customized Equipment (DME)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}