{
"Npi": {
"NPI": "1790127603",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ANY ACCIDENT CARE CLINIC PLLC",
"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": "607 W. DR. MARTIN LUTHER KING JR. BLVD",
"SecondLineMailingAddress": "SUITE 101",
"MailingAddressCityName": "TAMPA",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33603",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "727-474-9729",
"MailingAddressFaxNumber": "727-499-7899",
"FirstLinePracticeLocationAddress": "607 W DR MARTIN LUTHER KING JR BLVD",
"SecondLinePracticeLocationAddress": "SUITE 101",
"PracticeLocationAddressCityName": "TAMPA",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33603-3453",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "727-474-9729",
"PracticeLocationAddressFaxNumber": "727-499-7899",
"EnumerationDate": "07/19/2013",
"LastUpdateDate": "07/19/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GROTEKE",
"AuthorizedOfficialFirstName": "ERIC",
"AuthorizedOfficialMiddleName": "KRISTIAN",
"AuthorizedOfficialTitle": "OWNER/CHIROPRACTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "727-474-9729",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302F00000X",
"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": "CH 8772",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}