{
"Npi": {
"NPI": "1699016337",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "SHANNON MEDICAL CENTER",
"ParentOrgTIN": null,
"OrgName": "SHANNON MEDICAL CENTER",
"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": "120 E HARRIS AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN ANGELO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76903-5904",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2008 NINE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BRADY",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76825-7210",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "325-597-2901",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/05/2013",
"LastUpdateDate": "03/05/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HORNER",
"AuthorizedOfficialFirstName": "BRYAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "325-657-8266",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QE0700X",
"TaxonomyName": "End-Stage Renal Disease (ESRD) Treatment Clinic/Center",
"LicenseNumber": "APPLIED FOR",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}