{
"Npi": {
"NPI": "1912123472",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HIGH PLAINS HEALTH PROVIDERS",
"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": "1505 P B LN",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "WICHITA FALLS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76302-2631",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "940-766-6751",
"MailingAddressFaxNumber": "940-766-6753",
"FirstLinePracticeLocationAddress": "4515 LAKE VIEW DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WICHITA FALLS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76308-3308",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "940-766-6751",
"PracticeLocationAddressFaxNumber": "940-766-6753",
"EnumerationDate": "04/17/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLAY",
"AuthorizedOfficialFirstName": "GEORGE",
"AuthorizedOfficialMiddleName": "W",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "IV",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "940-766-6751",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "320600000X",
"TaxonomyName": "Intellectual and/or Developmental Disabilities Residential Treatment Facility",
"LicenseNumber": null,
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}