{
"Npi": {
"NPI": "1679797237",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "SAINT LOUIS CONNECTCARE",
"ParentOrgTIN": null,
"OrgName": "SAINT LOUIS CONNECTCARE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 795120",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT LOUIS",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63179-0795",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-879-6308",
"MailingAddressFaxNumber": "314-879-6372",
"FirstLinePracticeLocationAddress": "5535 DELMAR BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT LOUIS",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63112-3005",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "314-879-6308",
"PracticeLocationAddressFaxNumber": "314-879-6372",
"EnumerationDate": "04/12/2007",
"LastUpdateDate": "06/20/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEHNE",
"AuthorizedOfficialFirstName": "TERRI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RN",
"AuthorizedOfficialTelephoneNumber": "314-879-6308",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QE0800X",
"TaxonomyName": "Endoscopy Clinic/Center",
"LicenseNumber": "199-0",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}