{
"Npi": {
"NPI": "1659568590",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PATRICK HENRY MEDICAL LLC",
"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": "PO BOX 907",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHERMAN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75091-0907",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "903-893-1301",
"MailingAddressFaxNumber": "903-893-1437",
"FirstLinePracticeLocationAddress": "1708 BAKER RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SHERMAN",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75090-2473",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "903-893-1301",
"PracticeLocationAddressFaxNumber": "903-893-1437",
"EnumerationDate": "09/25/2007",
"LastUpdateDate": "07/03/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LOE",
"AuthorizedOfficialFirstName": "HENRY",
"AuthorizedOfficialMiddleName": "BLUME",
"AuthorizedOfficialTitle": "CEO OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "903-893-1301",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332BX2000X",
"TaxonomyName": "Oxygen Equipment & Supplies (DME)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "0099275",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}