{
"Npi": {
"NPI": "1841312584",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "CENTRAL NEBRASKA MEDICAL CLINIC, P.C.",
"ParentOrgTIN": null,
"OrgName": "CENTRAL NEBRASKA MEDICAL CLINIC, P.C.",
"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": "PO BOX 690",
"SecondLineMailingAddress": "145 MEMORIAL DRIVE",
"MailingAddressCityName": "BROKEN BOW",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "68822-0690",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "308-872-2486",
"MailingAddressFaxNumber": "308-872-2027",
"FirstLinePracticeLocationAddress": "706 MAIN ST.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ANSLEY",
"PracticeLocationAddressStateName": "NE",
"PracticeLocationAddressPostalCode": "68814-0706",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "308-935-1367",
"PracticeLocationAddressFaxNumber": "308-872-2027",
"EnumerationDate": "04/04/2007",
"LastUpdateDate": "06/11/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MINNICK",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "OWNER PARTNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "308-872-2486",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": "NE",
"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."
}
}
}
}