{
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"ReplacementNPI": null,
"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ACCESS URGENT CARE-KINGSVILLE LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 60112",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORPUS CHRISTI",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78466-0112",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "361-884-2904",
"MailingAddressFaxNumber": "361-884-1912",
"FirstLinePracticeLocationAddress": "401 E KING AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KINGSVILLE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78363-5666",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "361-884-2904",
"PracticeLocationAddressFaxNumber": "361-884-1912",
"EnumerationDate": "08/09/2018",
"LastUpdateDate": "07/13/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KENYON",
"AuthorizedOfficialFirstName": "PAUL",
"AuthorizedOfficialMiddleName": "DAVID",
"AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "361-884-2904",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": "H8172",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}