{
"Npi": {
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"EIN": null,
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"OrgName": "PORTLAND GASTROENTEROLOGY EQUIPMENT",
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"NamePrefix": null,
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"FirstLineMailingAddress": "541 NE 20TH AVE STE 225",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PORTLAND",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97232-2895",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-963-2801",
"MailingAddressFaxNumber": "503-963-2825",
"FirstLinePracticeLocationAddress": "1111 NE 99TH AVE STE 302",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PORTLAND",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97220-9442",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "503-963-2760",
"PracticeLocationAddressFaxNumber": "503-963-2825",
"EnumerationDate": "10/06/2016",
"LastUpdateDate": "09/18/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JAMISON",
"AuthorizedOfficialFirstName": "RICHARD",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "503-963-2801",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QE0800X",
"TaxonomyName": "Endoscopy Clinic/Center",
"LicenseNumber": "07-1535",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}