{
"Npi": {
"NPI": "1831508233",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PREMIUM MOBILE X-RAYS 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": "608 WALNUT BEND DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MANSFIELD",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76063-5850",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "682-401-0609",
"MailingAddressFaxNumber": "866-301-2005",
"FirstLinePracticeLocationAddress": "608 WALNUT BEND DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MANSFIELD",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76063-5850",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "682-401-0609",
"PracticeLocationAddressFaxNumber": "866-301-2005",
"EnumerationDate": "08/11/2014",
"LastUpdateDate": "08/11/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUTLER",
"AuthorizedOfficialFirstName": "STEVEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "FOUNDER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "972-965-1536",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0208X",
"TaxonomyName": "Mobile Radiology Clinic/Center",
"LicenseNumber": "802031012",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}