{
"Npi": {
"NPI": "1851439137",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH",
"ParentOrgTIN": null,
"OrgName": "TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH",
"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": "P.O. BOX 2526",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT WORTH",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76113-2526",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-820-0235",
"MailingAddressFaxNumber": "817-878-5250",
"FirstLinePracticeLocationAddress": "1512 PENNSYLVANIA AVENUE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT WORTH",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76104-2122",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-820-0235",
"PracticeLocationAddressFaxNumber": "817-878-5250",
"EnumerationDate": "02/01/2007",
"LastUpdateDate": "11/11/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BIGGINS",
"AuthorizedOfficialFirstName": "LILLIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "SENIOR VICE PRESIDENT",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "817-250-3722",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QX0100X",
"TaxonomyName": "Occupational Medicine Clinic/Center",
"LicenseNumber": "MDF4504",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QX0100X",
"TaxonomyName": "Occupational Medicine Clinic/Center",
"LicenseNumber": "000235",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}