{
"Npi": {
"NPI": "1669816799",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ADVANCED SURGERY OF INDIANA LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 56051",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "INDIANAPOLIS",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46256-0051",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "317-598-0094",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9470 BRIDGEWATER CIR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "INDIANAPOLIS",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "46250-3412",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "317-598-0094",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/19/2013",
"LastUpdateDate": "04/19/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MIMMS",
"AuthorizedOfficialFirstName": "SCOTT",
"AuthorizedOfficialMiddleName": "EDWARD",
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"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "317-679-1757",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "01068514A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}