{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "SAINT MARY'S OUTPATIENT SURGERY CENTER AT GALENA",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "18653 WEDGE PKWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RENO",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89511-3005",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "775-770-7218",
"MailingAddressFaxNumber": "775-770-7228",
"FirstLinePracticeLocationAddress": "18653 WEDGE PKWY",
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"PracticeLocationAddressCityName": "RENO",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "775-770-7218",
"PracticeLocationAddressFaxNumber": "775-770-7228",
"EnumerationDate": "11/01/2006",
"LastUpdateDate": "02/04/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JASMON",
"AuthorizedOfficialFirstName": "JOSEPH",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "EXECUTIVE VP - COO",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "775-770-6085",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "B0506616",
"LicenseNumberStateCode": "NV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}