{
"Npi": {
"NPI": "1801934989",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NEUROMUSCULOSKELETAL REHABILITATION AND PAIN CLINIC, P.C.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "600 W 8TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GILLETTE",
"MailingAddressStateName": "WY",
"MailingAddressPostalCode": "82716-4107",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "307-689-6277",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "646 JENNINGS AVE.",
"SecondLinePracticeLocationAddress": "STE #2",
"PracticeLocationAddressCityName": "HOT SPRINGS",
"PracticeLocationAddressStateName": "SD",
"PracticeLocationAddressPostalCode": "57747",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "605-745-5017",
"PracticeLocationAddressFaxNumber": "605-745-5017",
"EnumerationDate": "02/02/2007",
"LastUpdateDate": "06/01/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REIMER",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": "BRADLEY",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.C.",
"AuthorizedOfficialTelephoneNumber": "307-689-6277",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "863",
"LicenseNumberStateCode": "SD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}