{
"Npi": {
"NPI": "1962536326",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SANGRE DE CRISTO FAMILY PRACTICE ASSOC., P.C.",
"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": "712 MACON AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CANON CITY",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "81212-3314",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "719-275-8646",
"MailingAddressFaxNumber": "888-484-0223",
"FirstLinePracticeLocationAddress": "712 MACON AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CANON CITY",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "81212-3314",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "719-275-8646",
"PracticeLocationAddressFaxNumber": "888-484-0223",
"EnumerationDate": "03/15/2007",
"LastUpdateDate": "01/05/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BANKER",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "WAYNE",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "719-275-8646",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "27050",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}