{
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"IsOrgSubpart": "N",
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"OrgName": "PYRAMID PAIN & REHAB P.A.",
"LastName": null,
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"MiddleName": null,
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"FirstLineMailingAddress": "6447 MALAGA",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "IRVING",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75039-3191",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "214-765-6978",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3500 INTERSTATE 30",
"SecondLinePracticeLocationAddress": "BUILDING D, SUITE # 203",
"PracticeLocationAddressCityName": "MESQUITE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75150-2696",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "214-765-6978",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/23/2008",
"LastUpdateDate": "06/23/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VATTAM",
"AuthorizedOfficialFirstName": "SREENADHA",
"AuthorizedOfficialMiddleName": "R",
"AuthorizedOfficialTitle": "CEO",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "214-765-6978",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2081P2900X",
"TaxonomyName": "Pain Medicine (Physical Medicine & Rehabilitation) Physician",
"LicenseNumber": "M2851",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}