{
"Npi": {
"NPI": "1902612971",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HOSKINSON HEALTH & WELLNESS CLINIC 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": "201 W LAKEWAY RD STE 1004",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GILLETTE",
"MailingAddressStateName": "WY",
"MailingAddressPostalCode": "82718-6349",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "307-387-9850",
"MailingAddressFaxNumber": "307-387-9890",
"FirstLinePracticeLocationAddress": "201 W LAKEWAY RD STE 200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GILLETTE",
"PracticeLocationAddressStateName": "WY",
"PracticeLocationAddressPostalCode": "82718-6341",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "307-387-9850",
"PracticeLocationAddressFaxNumber": "307-387-9890",
"EnumerationDate": "12/05/2024",
"LastUpdateDate": "12/09/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOSKINSON",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PARTNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "303-917-3343",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "133V00000X",
"TaxonomyName": "Registered Dietitian",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "133VN1201X",
"TaxonomyName": "Obesity and Weight Management Nutrition Registered Dietitian",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207QS1201X",
"TaxonomyName": "Sleep Medicine (Family Medicine) Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
},
{
"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."
},
{
"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."
},
{
"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."
}
]
}
}
}