{
"Npi": {
"NPI": "1902063449",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MCLEOD RADIOLOGICAL SERVICES 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 207",
"SecondLineMailingAddress": "130 EAST FIFTH STREET",
"MailingAddressCityName": "NATCHITOCHES",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "71457",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "318-352-3492",
"MailingAddressFaxNumber": "318-352-3524",
"FirstLinePracticeLocationAddress": "501 KEYSER AVENUE",
"SecondLinePracticeLocationAddress": "NATCHITOCHES PARISH HOSPITAL",
"PracticeLocationAddressCityName": "NATCHITOCHES",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "71457",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "318-214-4274",
"PracticeLocationAddressFaxNumber": "318-214-4275",
"EnumerationDate": "05/21/2008",
"LastUpdateDate": "09/08/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCLEOD",
"AuthorizedOfficialFirstName": "EDNA",
"AuthorizedOfficialMiddleName": "W",
"AuthorizedOfficialTitle": "RADIOLOGIST OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "318-352-3492",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2085R0202X",
"TaxonomyName": "Diagnostic Radiology Physician",
"LicenseNumber": "009944",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}