{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "THE EXPRESS CLINIC, LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO 23048",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LINCOLN",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "68542",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "402-420-2094",
"MailingAddressFaxNumber": "402-420-2095",
"FirstLinePracticeLocationAddress": "2525 PINE LAKE ROAD PRACTICE LOCATION 68512",
"SecondLinePracticeLocationAddress": "PO 23048 68542",
"PracticeLocationAddressCityName": "LINCOLN",
"PracticeLocationAddressStateName": "NE",
"PracticeLocationAddressPostalCode": "68542",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "402-420-2094",
"PracticeLocationAddressFaxNumber": "402-420-2095",
"EnumerationDate": "12/18/2006",
"LastUpdateDate": "12/11/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TUCKER",
"AuthorizedOfficialFirstName": "BETTE",
"AuthorizedOfficialMiddleName": "GRACE",
"AuthorizedOfficialTitle": "OPERATIONS MANAGER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "NP",
"AuthorizedOfficialTelephoneNumber": "402-423-4739",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Clinic/Center",
"LicenseNumber": "219844341",
"LicenseNumberStateCode": "NE",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}