{
"Npi": {
"NPI": "1720664717",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "REVOLUTION BIRTH SERVICES",
"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": "404 N MAIN STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BELTON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76513",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "512-843-1715",
"MailingAddressFaxNumber": "254-523-4829",
"FirstLinePracticeLocationAddress": "404 N MAIN STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BELTON",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76513",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "512-843-1715",
"PracticeLocationAddressFaxNumber": "254-523-4829",
"EnumerationDate": "03/22/2021",
"LastUpdateDate": "12/29/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COCHRAN",
"AuthorizedOfficialFirstName": "ASHLEY",
"AuthorizedOfficialMiddleName": "K",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LM, CPM",
"AuthorizedOfficialTelephoneNumber": "512-843-1715",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "176B00000X",
"TaxonomyName": "Midwife",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "367A00000X",
"TaxonomyName": "Advanced Practice Midwife",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QB0400X",
"TaxonomyName": "Birthing Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}