{
"Npi": {
"NPI": "1962773515",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EXPRESS CARE & FAMILY PRACTICE CENTER, PA",
"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": "2080 W ARLINGTON BLVD STE A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GREENVILLE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27834-3770",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "252-439-0065",
"MailingAddressFaxNumber": "252-439-0071",
"FirstLinePracticeLocationAddress": "2080 W ARLINGTON BLVD STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GREENVILLE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27834-3770",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "252-439-0065",
"PracticeLocationAddressFaxNumber": "252-439-0071",
"EnumerationDate": "01/13/2012",
"LastUpdateDate": "01/13/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BEAMAN",
"AuthorizedOfficialFirstName": "CARLTON",
"AuthorizedOfficialMiddleName": "REID",
"AuthorizedOfficialTitle": "PHYSICIAN ASSISTANT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "PHYSICIAN ASSISTANT",
"AuthorizedOfficialTelephoneNumber": "252-439-0065",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "101911",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}