{
"Npi": {
"NPI": "1962845438",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JOSEPH SALLOUM, M.D. 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": "PO BOX 15158",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HATTIESBURG",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39404-5158",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-288-1701",
"MailingAddressFaxNumber": "601-288-1715",
"FirstLinePracticeLocationAddress": "301 S 28TH AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HATTIESBURG",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39401-7233",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-288-1701",
"PracticeLocationAddressFaxNumber": "601-288-1715",
"EnumerationDate": "04/15/2013",
"LastUpdateDate": "10/28/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FUNK",
"AuthorizedOfficialFirstName": "KATHY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "BILLING ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "877-434-2035",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2085R0001X",
"TaxonomyName": "Radiation Oncology Physician",
"LicenseNumber": "11850",
"LicenseNumberStateCode": "MS",
"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."
}
}
}
}