{
"Npi": {
"NPI": "1861403792",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ST LUCIE DIAGNOSTIC CENTER INC",
"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": "PO BOX 880009",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PORT ST LUCIE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34988-0009",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "772-468-4435",
"MailingAddressFaxNumber": "772-871-7822",
"FirstLinePracticeLocationAddress": "1700 S 23RD ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT PIERCE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34950-4803",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "772-468-4435",
"PracticeLocationAddressFaxNumber": "772-871-7822",
"EnumerationDate": "08/09/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PAREKH",
"AuthorizedOfficialFirstName": "KISHOR",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "772-468-4435",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2085R0202X",
"TaxonomyName": "Diagnostic Radiology Physician",
"LicenseNumber": "ME0043667",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}