{
"Npi": {
"NPI": "1902071418",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WEST FLORIDA PAIN MANAGEMENT PA",
"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": "603 7TH STREET SOUTH",
"SecondLineMailingAddress": "SUITE 340",
"MailingAddressCityName": "ST PETERSBURG",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33701-4732",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "727-553-7313",
"MailingAddressFaxNumber": "727-553-7320",
"FirstLinePracticeLocationAddress": "1831 N BELCHER RD",
"SecondLinePracticeLocationAddress": "A-2",
"PracticeLocationAddressCityName": "CLEARWATER",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33765-1449",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "727-553-7313",
"PracticeLocationAddressFaxNumber": "727-553-7320",
"EnumerationDate": "04/25/2008",
"LastUpdateDate": "04/25/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MONTGOMERY",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": "G",
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "727-553-7330",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "ME52154",
"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."
}
}
}
}