{
"Npi": {
"NPI": "1891803433",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DIVERSIFIED MANAGEMENT SERVICES LLC",
"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": "2727 W DR MARTIN LUTHER KING JR BLVD",
"SecondLineMailingAddress": "SUITE 120",
"MailingAddressCityName": "TAMPA",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33607",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "813-872-6722",
"MailingAddressFaxNumber": "813-872-6341",
"FirstLinePracticeLocationAddress": "10817 BLOOMINGDALE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIVERVIEW",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33569",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "813-662-5437",
"PracticeLocationAddressFaxNumber": "813-655-3025",
"EnumerationDate": "08/25/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HERNANDEZ",
"AuthorizedOfficialFirstName": "DENNIS",
"AuthorizedOfficialMiddleName": "ARNALDO",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "813-872-6722",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QU0200X",
"TaxonomyName": "Urgent Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}