{
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"OrgName": "KINGS BAY FAMILY CARE PA",
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"FirstLineMailingAddress": "14690 SPRING HILL DR",
"SecondLineMailingAddress": "SUITE 101",
"MailingAddressCityName": "SPRING HILL",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34609-8102",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-795-2273",
"MailingAddressFaxNumber": "352-795-2296",
"FirstLinePracticeLocationAddress": "9030 W FORT ISLAND TRL",
"SecondLinePracticeLocationAddress": "SUITE 1",
"PracticeLocationAddressCityName": "CRYSTAL RIVER",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "352-795-2273",
"PracticeLocationAddressFaxNumber": "352-795-2296",
"EnumerationDate": "06/03/2006",
"LastUpdateDate": "08/10/2012",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MUELLER",
"AuthorizedOfficialFirstName": "MICHAEL",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "352-795-2273",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "OS7801",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}