{
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"EIN": null,
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"OrgName": "OMAHA CHILDRENS CINIC P.C.",
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"FirstLineMailingAddress": "19102 Q STREET STE 102",
"SecondLineMailingAddress": "OMAHA CHILDRENS CLINIC P.C.",
"MailingAddressCityName": "OMAHA",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "68135-1558",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "402-330-5690",
"MailingAddressFaxNumber": "402-330-5689",
"FirstLinePracticeLocationAddress": "19102 Q STREET STE 102",
"SecondLinePracticeLocationAddress": "OMAHA CHILDRENS CLINIC P.C.",
"PracticeLocationAddressCityName": "OMAHA",
"PracticeLocationAddressStateName": "NE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "402-330-5690",
"PracticeLocationAddressFaxNumber": "402-330-5689",
"EnumerationDate": "09/13/2006",
"LastUpdateDate": "03/07/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VANN",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": "J.",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "402-330-5690",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "19479",
"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."
}
}
}
}