{
"Npi": {
"NPI": "1689928103",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CONWAY HOSPITAL COMMUNITY SERVICES",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 2180",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CONWAY",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29528-2180",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "843-234-5139",
"MailingAddressFaxNumber": "843-234-6822",
"FirstLinePracticeLocationAddress": "300 SINGLETON RIDGE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CONWAY",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29526-9142",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "843-347-8347",
"PracticeLocationAddressFaxNumber": "843-234-6977",
"EnumerationDate": "11/06/2012",
"LastUpdateDate": "05/10/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BARR",
"AuthorizedOfficialFirstName": "BRET",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "CFO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "843-347-7111",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}