{
"Npi": {
"NPI": "1700027927",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CONFEDERATED TRIBES OF THE WARM SPRINGS RESERVATION OF OREGON",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX C",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WARM SPRINGS",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97761-3001",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "541-553-3205",
"MailingAddressFaxNumber": "541-553-4900",
"FirstLinePracticeLocationAddress": "1115 WASCO STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WARM SPRINGS",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97761-3001",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "541-553-3205",
"PracticeLocationAddressFaxNumber": "541-553-4900",
"EnumerationDate": "03/18/2009",
"LastUpdateDate": "02/01/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STACONA",
"AuthorizedOfficialFirstName": "MICHELE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "SECRETARY/TREASURER-CEO",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MSW",
"AuthorizedOfficialTelephoneNumber": "541-553-3232",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}