{
"Npi": {
"NPI": "1851711642",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MAIN STREET MEDICAL & COUNSELING CENTER PLC",
"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": "103 E MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PINCKNEY",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48169-8095",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "734-474-1525",
"MailingAddressFaxNumber": "734-878-5103",
"FirstLinePracticeLocationAddress": "103 E. MAIN ST.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PINCKNEY",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48169",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "734-474-1525",
"PracticeLocationAddressFaxNumber": "734-878-5103",
"EnumerationDate": "04/21/2014",
"LastUpdateDate": "02/06/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOLDMAN",
"AuthorizedOfficialFirstName": "MITCHELL",
"AuthorizedOfficialMiddleName": "DENNIS",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "734-972-9184",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "4301083561",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}