{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "FAMILY MEDICINE & SURGERY LLC",
"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "3066 MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EAST TROY",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53120-1148",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "262-642-7313",
"MailingAddressFaxNumber": "262-642-4251",
"FirstLinePracticeLocationAddress": "3066 MAIN ST",
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"PracticeLocationAddressCityName": "EAST TROY",
"PracticeLocationAddressStateName": "WI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-642-7313",
"PracticeLocationAddressFaxNumber": "262-642-4251",
"EnumerationDate": "02/24/2011",
"LastUpdateDate": "02/24/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RENNICK",
"AuthorizedOfficialFirstName": "NEIL",
"AuthorizedOfficialMiddleName": "JAMES",
"AuthorizedOfficialTitle": "SOLE PROPRIETOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "262-642-7313",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208D00000X",
"TaxonomyName": "General Practice Physician",
"LicenseNumber": "26462",
"LicenseNumberStateCode": "WI",
"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."
}
}
}
}