{
"Npi": {
"NPI": "1679026256",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TRAILHEAD CLINICS",
"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": "235 N 7TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRAND JUNCTION",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "81501-3401",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "970-644-5999",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "235 N 7TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRAND JUNCTION",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "81501-3401",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "970-644-5999",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/29/2016",
"LastUpdateDate": "07/29/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOYER",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "TODD",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "970-644-5999",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "50272",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}