{
"Npi": {
"NPI": "1689875312",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FREE CLINIC OF DANVILLE",
"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": "133 S RIDGE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DANVILLE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24541-1313",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "434-799-1223",
"MailingAddressFaxNumber": "434-799-6737",
"FirstLinePracticeLocationAddress": "133 S RIDGE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DANVILLE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24541-1313",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "434-799-1223",
"PracticeLocationAddressFaxNumber": "434-799-6737",
"EnumerationDate": "05/30/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARVIE",
"AuthorizedOfficialFirstName": "EDWIN",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "434-799-1123",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "0101013597",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}