{
"Npi": {
"NPI": "1972785558",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "COMPREHENSIVE FOOT CENTERS",
"ParentOrgTIN": null,
"OrgName": "COMPREHENSIVE FOOT CENTERS",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherMiddleName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5601 NE ANTIOCH RD",
"SecondLineMailingAddress": "SUITE 7",
"MailingAddressCityName": "GLADSTONE",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "64119-2302",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "816-455-1155",
"MailingAddressFaxNumber": "816-455-1161",
"FirstLinePracticeLocationAddress": "5601 NE ANTIOCH RD",
"SecondLinePracticeLocationAddress": "SUITE 7",
"PracticeLocationAddressCityName": "GLADSTONE",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "64119-2302",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "816-455-1155",
"PracticeLocationAddressFaxNumber": "816-455-1161",
"EnumerationDate": "12/05/2007",
"LastUpdateDate": "12/05/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOLDRY",
"AuthorizedOfficialFirstName": "THOMAS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "816-455-1155",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": null,
"LicenseNumberStateCode": "MO",
"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."
}
}
}
}