{
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"OrgName": "PEDIATRIC SPECIALTY RURAL HEALTH CLINIC",
"LastName": null,
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"NamePrefix": null,
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"OtherOrgName": null,
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"FirstLineMailingAddress": "PO BOX 2368",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EAGLE PASS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78853-2368",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "830-773-1103",
"MailingAddressFaxNumber": "830-757-8366",
"FirstLinePracticeLocationAddress": "710 WILLIAMS ST",
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"PracticeLocationAddressCityName": "EAGLE PASS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78852-5126",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "830-773-1103",
"PracticeLocationAddressFaxNumber": "830-757-8366",
"EnumerationDate": "03/21/2007",
"LastUpdateDate": "11/03/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DE LOS SANTOS",
"AuthorizedOfficialFirstName": "DEBRA",
"AuthorizedOfficialMiddleName": "W",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "830-773-1103",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "F3442",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}