{
"Npi": {
"NPI": "1649531377",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "DHHS INDIAN HEALTH SERVICE",
"ParentOrgTIN": null,
"OrgName": "PEACH SPRINGS HEALTH CENTER",
"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": "3350 HARRISON ST",
"SecondLineMailingAddress": "H157",
"MailingAddressCityName": "KINGMAN",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "86409-0700",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "943 HUALAPAI WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PEACH SPRINGS",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "86434-0190",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "928-769-2906",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/29/2012",
"LastUpdateDate": "05/29/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SULLIVAN",
"AuthorizedOfficialFirstName": "ROSEMARY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "HEALTH CENTER DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "928-769-4369",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}