{
"Npi": {
"NPI": "1811085459",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GASTROINTESTINAL DIAGNOSTIC CLINIC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3196 S MARYLAND PKWY",
"SecondLineMailingAddress": "SUITE 207",
"MailingAddressCityName": "LAS VEGAS",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89109-2305",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "702-369-3400",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3196 S MARYLAND PKWY",
"SecondLinePracticeLocationAddress": "SUITE 207",
"PracticeLocationAddressCityName": "LAS VEGAS",
"PracticeLocationAddressStateName": "NV",
"PracticeLocationAddressPostalCode": "89109-2305",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "702-369-3400",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/10/2006",
"LastUpdateDate": "10/18/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LONDON",
"AuthorizedOfficialFirstName": "JACK",
"AuthorizedOfficialMiddleName": "GERARD",
"AuthorizedOfficialTitle": "SENIOR CONSULTANT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MBA/MHA",
"AuthorizedOfficialTelephoneNumber": "702-737-7555",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "477ASC-8",
"LicenseNumberStateCode": "NV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}