{
"Npi": {
"NPI": "1902279060",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MED PLUS 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": "875 W POPLAR AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLLIERVILLE",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38017-2513",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "901-562-3055",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "875 W POPLAR AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COLLIERVILLE",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "38017-2513",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "901-562-3055",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/10/2015",
"LastUpdateDate": "11/10/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GIBONEY",
"AuthorizedOfficialFirstName": "P",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "VP",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "901-562-3055",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "347E00000X",
"TaxonomyName": "Transportation Broker",
"LicenseNumber": null,
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3104A0630X",
"TaxonomyName": "Assisted Living Facility (Behavioral Disturbances)",
"LicenseNumber": null,
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}