{
"Npi": {
"NPI": "1669670816",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WAYNESBURG CLINIC, PLLC",
"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": "PO BOX 435",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WAYNESBURG",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40489-0435",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "606-379-6646",
"MailingAddressFaxNumber": "606-379-5707",
"FirstLinePracticeLocationAddress": "14098 US HIGHWAY 27 S",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WAYNESBURG",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "40489-8253",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "606-379-6646",
"PracticeLocationAddressFaxNumber": "606-379-5707",
"EnumerationDate": "07/10/2007",
"LastUpdateDate": "10/04/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIMS",
"AuthorizedOfficialFirstName": "CHRISTOPHER",
"AuthorizedOfficialMiddleName": "DUVALL",
"AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "606-365-1547",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR1300X",
"TaxonomyName": "Rural Health Clinic/Center",
"LicenseNumber": "900205",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}