{
"Npi": {
"NPI": "1710201769",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ADVANCED AUDIOLOGY SERVICES, LLC",
"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": "3158 GRATIOT BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MARYSVILLE",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48040-1488",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "810-388-9400",
"MailingAddressFaxNumber": "810-388-9434",
"FirstLinePracticeLocationAddress": "3158 GRATIOT BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MARYSVILLE",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48040-1488",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "810-388-9400",
"PracticeLocationAddressFaxNumber": "810-388-9434",
"EnumerationDate": "03/19/2010",
"LastUpdateDate": "12/16/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BONT",
"AuthorizedOfficialFirstName": "LISA",
"AuthorizedOfficialMiddleName": "DANIELLE",
"AuthorizedOfficialTitle": "AUDIOLOGIST / OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MA CCC-A",
"AuthorizedOfficialTelephoneNumber": "810-388-9400",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "237600000X",
"TaxonomyName": "Audiologist-Hearing Aid Fitter",
"LicenseNumber": "1601000490",
"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."
}
}
}
}