{
"Npi": {
"NPI": "1720467236",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TUCSON PAIN TREATMENT CENTER, 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": "6252 E GRANT RD",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "TUCSON",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85712-5803",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "520-886-7246",
"MailingAddressFaxNumber": "520-901-2929",
"FirstLinePracticeLocationAddress": "6252 E GRANT RD",
"SecondLinePracticeLocationAddress": "SUITE 100",
"PracticeLocationAddressCityName": "TUCSON",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85712-5803",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "520-886-7246",
"PracticeLocationAddressFaxNumber": "520-901-2929",
"EnumerationDate": "05/29/2015",
"LastUpdateDate": "05/29/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STEVENS",
"AuthorizedOfficialFirstName": "CHARLES",
"AuthorizedOfficialMiddleName": "R",
"AuthorizedOfficialTitle": "OWNER / PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "520-886-7246",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "41804",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}