{
"Npi": {
"NPI": "1730288556",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FAMILY HEALTH PARTNERS OF THE QUAD CITIES, PC",
"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": "3385 DEXTER CT",
"SecondLineMailingAddress": "SUITE 103",
"MailingAddressCityName": "DAVENPORT",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "52807-3471",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "563-441-5860",
"MailingAddressFaxNumber": "563-441-5865",
"FirstLinePracticeLocationAddress": "3385 DEXTER CT",
"SecondLinePracticeLocationAddress": "SUITE 103",
"PracticeLocationAddressCityName": "DAVENPORT",
"PracticeLocationAddressStateName": "IA",
"PracticeLocationAddressPostalCode": "52807-3471",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "563-441-5860",
"PracticeLocationAddressFaxNumber": "563-441-5865",
"EnumerationDate": "09/21/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WALCZYK",
"AuthorizedOfficialFirstName": "JEFFREY",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "563-441-5860",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "26742",
"LicenseNumberStateCode": "IA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}