{
"Npi": {
"NPI": "1720023724",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GREAT LAKES ORTHOTICS & PROSTHETICS INC.",
"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": "3950 EVERGREEN CT STE A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "APPLETON",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54913-8903",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "920-968-2240",
"MailingAddressFaxNumber": "920-968-2241",
"FirstLinePracticeLocationAddress": "3950 EVERGREEN CT STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "APPLETON",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54913-8903",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "920-968-2240",
"PracticeLocationAddressFaxNumber": "920-968-2241",
"EnumerationDate": "06/17/2006",
"LastUpdateDate": "06/09/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALGER",
"AuthorizedOfficialFirstName": "PERRY",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CO",
"AuthorizedOfficialTelephoneNumber": "920-968-2240",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}