{
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"OrgName": "RUSSELLVILLE PHYSICIAN PRACTICES LLC",
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"FirstLineMailingAddress": "PO BOX 1216",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RUSSELLVILLE",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "35653-1216",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "256-332-1533",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "15225 HIGHWAY 43",
"SecondLinePracticeLocationAddress": "SUITE I",
"PracticeLocationAddressCityName": "RUSSELLVILLE",
"PracticeLocationAddressStateName": "AL",
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"PracticeLocationAddressTelephoneNumber": "256-332-1533",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/08/2013",
"LastUpdateDate": "07/08/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MANGUM",
"AuthorizedOfficialFirstName": "ANGIE",
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"AuthorizedOfficialTitle": "SR DIRECTOR",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "615-565-1898",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}