{
"Npi": {
"NPI": "1649718321",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "SOUTHWEST GENERAL HEALTH CENTER",
"ParentOrgTIN": null,
"OrgName": "SOUTHWEST GENERAL HEALTH CENTER",
"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": "18697 BAGLEY RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIDDLEBURG HEIGHTS",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44130-3417",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "440-816-8000",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "15345 BAGLEY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MIDDLEBURG HEIGHTS",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44130-4825",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "440-743-8400",
"PracticeLocationAddressFaxNumber": "440-743-8401",
"EnumerationDate": "02/02/2017",
"LastUpdateDate": "03/14/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "YOUNG",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT/CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "440-816-6701",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "0782AS",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}