{
"Npi": {
"NPI": "1669214995",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MHC SCADDEN, MD, PC",
"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": "1049 E AUGUSTA ST UNIT 954",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WOODBRIDGE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95258-4032",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1800 N CALIFORNIA ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STOCKTON",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95204-6019",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "209-943-4000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/07/2024",
"LastUpdateDate": "06/07/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCADDEN",
"AuthorizedOfficialFirstName": "MICK'L",
"AuthorizedOfficialMiddleName": "HAYES C",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "707-955-5575",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207L00000X",
"TaxonomyName": "Anesthesiology 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."
}
}
}
}