{
"Npi": {
"NPI": "1659566719",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COMMUNITY MEDICAL CLINIC",
"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": "8 S BROADVIEW",
"SecondLineMailingAddress": "SUITES 5 & 6",
"MailingAddressCityName": "GREENBRIER",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72058-1169",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "501-581-0207",
"MailingAddressFaxNumber": "501-581-0209",
"FirstLinePracticeLocationAddress": "8 S BROADVIEW ST",
"SecondLinePracticeLocationAddress": "SUITES 5 & 6",
"PracticeLocationAddressCityName": "GREENBRIER",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72058-9601",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "501-581-0207",
"PracticeLocationAddressFaxNumber": "501-581-0209",
"EnumerationDate": "09/12/2007",
"LastUpdateDate": "09/12/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCCARLEY",
"AuthorizedOfficialFirstName": "CAROLYN",
"AuthorizedOfficialMiddleName": "REBECCA",
"AuthorizedOfficialTitle": "APN",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "APN",
"AuthorizedOfficialTelephoneNumber": "501-581-0207",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "F1104137",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}