{
"Npi": {
"NPI": "1659195386",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CATHEDRAL LEDGE MEDICAL SUPPLIES LLC",
"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": "PO BOX 2238",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH CONWAY",
"MailingAddressStateName": "NH",
"MailingAddressPostalCode": "03860-2238",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "603-662-2557",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1857 WHITE MOUNTAIN HWY UNIT 1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH CONWAY",
"PracticeLocationAddressStateName": "NH",
"PracticeLocationAddressPostalCode": "03860-5158",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "603-662-2557",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/11/2024",
"LastUpdateDate": "11/11/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIDDIQUI",
"AuthorizedOfficialFirstName": "SOHAIB",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PROVIDER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "603-662-2557",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}