{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "AMG OF WASHINGTON PC",
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"FirstName": null,
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"FirstLineMailingAddress": "4045 E BELL RD STE 157",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHOENIX",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85032-2240",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2320 130TH AVE NE STE 220",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BELLEVUE",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98005-1718",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "888-506-1858",
"PracticeLocationAddressFaxNumber": "888-508-5161",
"EnumerationDate": "10/28/2020",
"LastUpdateDate": "11/28/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NOONAN",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "J",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "888-506-1858",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}