{
"Npi": {
"NPI": "1679705776",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "UNIFIED HEALTH SYSTEMS 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": "4601 MILITARY TRL",
"SecondLineMailingAddress": "SUITE 205",
"MailingAddressCityName": "JUPITER",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33458-4834",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-624-9744",
"MailingAddressFaxNumber": "561-624-9744",
"FirstLinePracticeLocationAddress": "4601 MILITARY TRL",
"SecondLinePracticeLocationAddress": "SUITE 205",
"PracticeLocationAddressCityName": "JUPITER",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33458-4834",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-624-9744",
"PracticeLocationAddressFaxNumber": "561-624-9744",
"EnumerationDate": "08/23/2009",
"LastUpdateDate": "08/23/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TIEGEN",
"AuthorizedOfficialFirstName": "RICHARD",
"AuthorizedOfficialMiddleName": "MILTON",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DMD. AP",
"AuthorizedOfficialTelephoneNumber": "561-624-9744",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": "0000691",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}