{
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"EIN": null,
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"FirstLineMailingAddress": "200 BARTLETT DR",
"SecondLineMailingAddress": "SUITE 108",
"MailingAddressCityName": "EL PASO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "79912-1628",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "915-581-7960",
"MailingAddressFaxNumber": "915-584-7599",
"FirstLinePracticeLocationAddress": "200 BARTLETT DR",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "915-581-7960",
"PracticeLocationAddressFaxNumber": "915-584-7599",
"EnumerationDate": "05/03/2006",
"LastUpdateDate": "04/17/2008",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PENDERGRAS",
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"AuthorizedOfficialTelephoneNumber": "915-581-6644",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332BP3500X",
"TaxonomyName": "Parenteral & Enteral Nutrition Supplies (DME)",
"LicenseNumber": "33BP3500X",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}