{
"Npi": {
"NPI": "1922142777",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "MEMORIAL HOSPITAL OF CARBON COUNTY",
"ParentOrgTIN": null,
"OrgName": "MEMORIAL HOSPITAL OF CARBON COUNTY",
"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": "2012 W ELM STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RAWLINS",
"MailingAddressStateName": "WY",
"MailingAddressPostalCode": "82301",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "307-324-6022",
"MailingAddressFaxNumber": "307-324-3835",
"FirstLinePracticeLocationAddress": "2012 W ELM STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RAWLINS",
"PracticeLocationAddressStateName": "WY",
"PracticeLocationAddressPostalCode": "82301",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "307-324-6022",
"PracticeLocationAddressFaxNumber": "307-324-3835",
"EnumerationDate": "02/16/2007",
"LastUpdateDate": "06/15/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KEPLINGER",
"AuthorizedOfficialFirstName": "MICHELLE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CFO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "307-324-8347",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207X00000X",
"TaxonomyName": "Orthopaedic Surgery Physician",
"LicenseNumber": "5186A",
"LicenseNumberStateCode": "WY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}