{
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"EIN": null,
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"IsOrgSubpart": "Y",
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"NamePrefix": null,
"NameSuffix": null,
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"OtherOrgName": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "PO BOX 1810",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SCOTTSDALE",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85252-1810",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "602-973-9800",
"MailingAddressFaxNumber": "602-973-9933",
"FirstLinePracticeLocationAddress": "5501 N 19TH AVE",
"SecondLinePracticeLocationAddress": "SUITE 111",
"PracticeLocationAddressCityName": "PHOENIX",
"PracticeLocationAddressStateName": "AZ",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "602-973-9800",
"PracticeLocationAddressFaxNumber": "602-973-9933",
"EnumerationDate": "04/12/2010",
"LastUpdateDate": "04/12/2010",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DERHAAG",
"AuthorizedOfficialFirstName": "DANIEL",
"AuthorizedOfficialMiddleName": "ALAN",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "602-973-9800",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Radiology Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}