{
"Npi": {
"NPI": "1932436672",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FAIRBANKS PAIN CONSULTING, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3030 DAVIS RD",
"SecondLineMailingAddress": "C7",
"MailingAddressCityName": "FAIRBANKS",
"MailingAddressStateName": "AK",
"MailingAddressPostalCode": "99709-5233",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "907-460-0222",
"MailingAddressFaxNumber": "907-458-6415",
"FirstLinePracticeLocationAddress": "1919 LATHROP ST",
"SecondLinePracticeLocationAddress": "SUITE 221",
"PracticeLocationAddressCityName": "FAIRBANKS",
"PracticeLocationAddressStateName": "AK",
"PracticeLocationAddressPostalCode": "99701-5937",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "907-458-5638",
"PracticeLocationAddressFaxNumber": "907-458-6415",
"EnumerationDate": "11/16/2009",
"LastUpdateDate": "11/16/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JIANG",
"AuthorizedOfficialFirstName": "SHAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "907-458-5638",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP3300X",
"TaxonomyName": "Pain Clinic/Center",
"LicenseNumber": "124884",
"LicenseNumberStateCode": "AK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}