{
"Npi": {
"NPI": "1699813006",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AMETHYST MEDICAL OFFICES PLC",
"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": "8200 E JEFFERSON AVE",
"SecondLineMailingAddress": "APT 709",
"MailingAddressCityName": "DETROIT",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48214-3974",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "313-822-0308",
"MailingAddressFaxNumber": "313-921-3628",
"FirstLinePracticeLocationAddress": "3741 MCDOUGALL ST",
"SecondLinePracticeLocationAddress": "SUITE 2",
"PracticeLocationAddressCityName": "DETROIT",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48207-2345",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "313-921-4327",
"PracticeLocationAddressFaxNumber": "313-921-3628",
"EnumerationDate": "02/01/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOSHUA",
"AuthorizedOfficialFirstName": "ALEXA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "FOUNDER PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "313-921-4327",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "4301406975",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}