{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "DEPT OF HEALTH AND HUMAN SERVICES PHS INDIAN HEALTH SERVICE",
"LastName": null,
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"NamePrefix": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "701 MARKET DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OKLAHOMA CITY",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73114-8132",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "405-951-3815",
"MailingAddressFaxNumber": "405-951-3916",
"FirstLinePracticeLocationAddress": "701 MARKET DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OKLAHOMA CITY",
"PracticeLocationAddressStateName": "OK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "405-951-3815",
"PracticeLocationAddressFaxNumber": "405-951-3916",
"EnumerationDate": "02/06/2017",
"LastUpdateDate": "02/06/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JENNINGS",
"AuthorizedOfficialFirstName": "ANGIE",
"AuthorizedOfficialMiddleName": "CAROL",
"AuthorizedOfficialTitle": "ADMINISTRATIVE ASSISTANT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "405-615-8971",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302F00000X",
"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}