{
"Npi": {
"NPI": "1760974265",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LCC MEDICAL CLINIC",
"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": "120 E MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LEIPSIC",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45856-1427",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "419-943-7400",
"MailingAddressFaxNumber": "419-943-7401",
"FirstLinePracticeLocationAddress": "120 E MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LEIPSIC",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45856-1427",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "419-943-7400",
"PracticeLocationAddressFaxNumber": "419-943-7401",
"EnumerationDate": "05/31/2018",
"LastUpdateDate": "05/31/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CAIN",
"AuthorizedOfficialFirstName": "JOSHUA",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "PHARMACIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARM.D., BCPS, BCOP",
"AuthorizedOfficialTelephoneNumber": "419-302-4790",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": "022883700",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}