{
"Npi": {
"NPI": "1831327170",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DOMINION DIAGNOSTICS, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "211 CIRCUIT DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH KINGSTOWN",
"MailingAddressStateName": "RI",
"MailingAddressPostalCode": "02852-7440",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "877-734-9600",
"MailingAddressFaxNumber": "401-667-0330",
"FirstLinePracticeLocationAddress": "1191 S BROWNELL RD",
"SecondLinePracticeLocationAddress": "SUITE 30",
"PracticeLocationAddressCityName": "WILLISTON",
"PracticeLocationAddressStateName": "VT",
"PracticeLocationAddressPostalCode": "05495-7415",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "802-651-4060",
"PracticeLocationAddressFaxNumber": "802-651-0736",
"EnumerationDate": "06/25/2009",
"LastUpdateDate": "12/14/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ELLIS",
"AuthorizedOfficialFirstName": "BRANDY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PAYER RELATIONS REP",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "802-734-6392",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": "LCI 00343",
"LicenseNumberStateCode": "RI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}