{
"Npi": {
"NPI": "1669480422",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "INDEPENDENT DIALYSIS FOUNDATION, INC",
"ParentOrgTIN": null,
"OrgName": "INDEPENDENT DIALYSIS FOUNDATION, INC",
"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": "840 HOLLINS ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BALTIMORE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21201-1024",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "410-468-0900",
"MailingAddressFaxNumber": "410-468-0911",
"FirstLinePracticeLocationAddress": "225 W DARES BEACH RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PRINCE FREDERICK",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20678-3123",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "410-468-0900",
"PracticeLocationAddressFaxNumber": "410-468-0911",
"EnumerationDate": "08/04/2006",
"LastUpdateDate": "07/16/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AYELE",
"AuthorizedOfficialFirstName": "ZEKE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR OF INFORMATION SYSTEMS",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "410-468-0900",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QE0700X",
"TaxonomyName": "End-Stage Renal Disease (ESRD) Treatment Clinic/Center",
"LicenseNumber": "E2549R",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}