{
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"OrgName": "BALCONES HEALTHCARE ASSOCIATES, PA",
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"FirstLineMailingAddress": "PO BOX 268969",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OKLAHOMA CITY",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73126-8969",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "512-868-4352",
"MailingAddressFaxNumber": "512-868-4354",
"FirstLinePracticeLocationAddress": "200 COUNTY ROAD 340A",
"SecondLinePracticeLocationAddress": "BUILDING 1, SUITE 4",
"PracticeLocationAddressCityName": "BURNET",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "512-868-4352",
"PracticeLocationAddressFaxNumber": "512-868-4354",
"EnumerationDate": "06/23/2009",
"LastUpdateDate": "01/25/2011",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BURGEST",
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"AuthorizedOfficialCredential": "M.D.",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Pain Medicine Physician",
"LicenseNumber": "L9637",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}