{
"Npi": {
"NPI": "1699838912",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "IREDELL MEMORIAL HOSPITAL, INCORPORATED",
"ParentOrgTIN": null,
"OrgName": "IREDELL MEMORIAL HOSPITAL, INCORPORATED",
"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": "557 BROOKDALE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STATESVILLE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28677-4107",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-873-5661",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "557 BROOKDALE DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STATESVILLE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28677-4107",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-873-5661",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/18/2006",
"LastUpdateDate": "08/03/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RUSH",
"AuthorizedOfficialFirstName": "ED",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "704-873-5661",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "163WD0400X",
"TaxonomyName": "Diabetes Educator Registered Nurse",
"LicenseNumber": "003515",
"LicenseNumberStateCode": "NC",
"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."
}
}
}
}