{
"Npi": {
"NPI": "1720145717",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROFESSIONAL CARE SERVICES OF WEST TN INC",
"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": "1997 HIGHWAY 51 S",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COVINGTON",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38019-3630",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "901-475-3586",
"MailingAddressFaxNumber": "901-313-1153",
"FirstLinePracticeLocationAddress": "1997 HIGHWAY 51 S",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COVINGTON",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "38019-3630",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "901-475-3586",
"PracticeLocationAddressFaxNumber": "901-313-1153",
"EnumerationDate": "01/02/2007",
"LastUpdateDate": "07/09/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRIFFIN",
"AuthorizedOfficialFirstName": "TOM",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CONTROLLER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "901-622-1688",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "189",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336L0003X",
"TaxonomyName": "Long Term Care Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}