{
"Npi": {
"NPI": "1912173907",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LIMB SALVAGE INTERNATIONAL",
"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": "1 PLAZA SOUTH ST",
"SecondLineMailingAddress": "PMB 140",
"MailingAddressCityName": "TAHLEQUAH",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "74464-4750",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "918-458-9888",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3413 N 14TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PONCA CITY",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "74601-1039",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "580-718-0002",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/30/2008",
"LastUpdateDate": "04/30/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BURK",
"AuthorizedOfficialFirstName": "JULIET",
"AuthorizedOfficialMiddleName": "C.",
"AuthorizedOfficialTitle": "COO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.P.M.",
"AuthorizedOfficialTelephoneNumber": "918-458-9888",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0100X",
"TaxonomyName": "Health Service Clinic/Center",
"LicenseNumber": "23029",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}