{
"Npi": {
"NPI": "1871901322",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUPREME HEALTHCARE SUPPLY LLC",
"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": "1035 NE 125TH ST",
"SecondLineMailingAddress": "301",
"MailingAddressCityName": "NORTH MIAMI",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33161-5820",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-859-3350",
"MailingAddressFaxNumber": "305-928-2535",
"FirstLinePracticeLocationAddress": "1035 NE 125TH ST",
"SecondLinePracticeLocationAddress": "301",
"PracticeLocationAddressCityName": "NORTH MIAMI",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33161-5820",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "305-859-3350",
"PracticeLocationAddressFaxNumber": "305-928-2535",
"EnumerationDate": "07/29/2014",
"LastUpdateDate": "09/13/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RUIZ-OTERO",
"AuthorizedOfficialFirstName": "IVAN",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "305-859-3350",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332BC3200X",
"TaxonomyName": "Customized Equipment (DME)",
"LicenseNumber": "PED218",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}