{
"Npi": {
"NPI": "1881876837",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROFESSIONAL IMAGING SERVICES, INC.",
"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": "2785 KURTZ ST",
"SecondLineMailingAddress": "SUITE 7",
"MailingAddressCityName": "SAN DIEGO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92110-3111",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-220-4972",
"MailingAddressFaxNumber": "619-220-8941",
"FirstLinePracticeLocationAddress": "2785 KURTZ ST",
"SecondLinePracticeLocationAddress": "SUITE 7",
"PracticeLocationAddressCityName": "SAN DIEGO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92110-3111",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-220-4972",
"PracticeLocationAddressFaxNumber": "619-220-8941",
"EnumerationDate": "12/01/2007",
"LastUpdateDate": "12/01/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FORD",
"AuthorizedOfficialFirstName": "STEVEN",
"AuthorizedOfficialMiddleName": "RICHARD",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "EE, MBA",
"AuthorizedOfficialTelephoneNumber": "619-220-4972",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335V00000X",
"TaxonomyName": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}