{
"Npi": {
"NPI": "1780990457",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LAKESIDE HEALTHCARE LLC",
"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": "1010 W 5TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "REDFIELD",
"MailingAddressStateName": "SD",
"MailingAddressPostalCode": "57469-2026",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "605-472-2191",
"MailingAddressFaxNumber": "605-472-2194",
"FirstLinePracticeLocationAddress": "1010 W 5TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "REDFIELD",
"PracticeLocationAddressStateName": "SD",
"PracticeLocationAddressPostalCode": "57469-2026",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "605-472-2191",
"PracticeLocationAddressFaxNumber": "605-472-2194",
"EnumerationDate": "08/19/2010",
"LastUpdateDate": "08/19/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEMMER",
"AuthorizedOfficialFirstName": "ROSANNE",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "605-472-2191",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302F00000X",
"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": "40127",
"LicenseNumberStateCode": "SD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}