{
"Npi": {
"NPI": "1821229006",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EDWARD HEALTH VENTURES",
"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": "27555 DIEHL ROAD",
"SecondLineMailingAddress": "ENTRANCE B",
"MailingAddressCityName": "WARRENVILLE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60555",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-646-3950",
"MailingAddressFaxNumber": "630-548-6832",
"FirstLinePracticeLocationAddress": "16151 WEBER ROAD",
"SecondLinePracticeLocationAddress": "STE 201",
"PracticeLocationAddressCityName": "CREST HILL",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60403-0865",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "815-838-2888",
"PracticeLocationAddressFaxNumber": "815-838-0222",
"EnumerationDate": "08/05/2009",
"LastUpdateDate": "10/01/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOTTMAN",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "630-646-3950",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}