{
"Npi": {
"NPI": "1780828814",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTHEASTERN IMAGING ASSOCIATES INC",
"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": "8461 LAKE WORTH RD",
"SecondLineMailingAddress": "SUITE 235",
"MailingAddressCityName": "LAKE WORTH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33467-2474",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-422-3372",
"MailingAddressFaxNumber": "561-422-3377",
"FirstLinePracticeLocationAddress": "8461 LAKE WORTH RD",
"SecondLinePracticeLocationAddress": "SUITE 235",
"PracticeLocationAddressCityName": "LAKE WORTH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33467-2474",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-422-3372",
"PracticeLocationAddressFaxNumber": "561-422-3377",
"EnumerationDate": "04/20/2009",
"LastUpdateDate": "01/18/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GONZALEZ",
"AuthorizedOfficialFirstName": "RONALD",
"AuthorizedOfficialMiddleName": "ENRIQUE",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RDMS, RDCS, RVT",
"AuthorizedOfficialTelephoneNumber": "954-325-3911",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": "HCC8538",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}