{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "CROSSROADS MEDICAL EQUIPMENT & SUPPLY, INC.",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1514 S 77 SUNSHINESTRIP",
"SecondLineMailingAddress": "SUITE #13",
"MailingAddressCityName": "HARLINGEN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78550-7208",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "956-444-0555",
"MailingAddressFaxNumber": "956-444-0702",
"FirstLinePracticeLocationAddress": "1514 S 77 SUNSHINESTRIP",
"SecondLinePracticeLocationAddress": "SUITE #13",
"PracticeLocationAddressCityName": "HARLINGEN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "956-444-0555",
"PracticeLocationAddressFaxNumber": "956-444-0702",
"EnumerationDate": "07/21/2006",
"LastUpdateDate": "10/22/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WELLS",
"AuthorizedOfficialFirstName": "LISA",
"AuthorizedOfficialMiddleName": "ANN",
"AuthorizedOfficialTitle": "OWNER ADMINISTRATOR",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "956-444-0555",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "0061347",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}