{
"Npi": {
"NPI": "1992036412",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WK SPINE INSTITUTE",
"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": "1202 LOUISIANA AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHREVEPORT",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "71101-3910",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "318-212-4889",
"MailingAddressFaxNumber": "318-212-4153",
"FirstLinePracticeLocationAddress": "2551 GREENWOOD RD",
"SecondLinePracticeLocationAddress": "SUITE 320",
"PracticeLocationAddressCityName": "SHREVEPORT",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "71103-3981",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "318-212-8546",
"PracticeLocationAddressFaxNumber": "318-212-4153",
"EnumerationDate": "01/22/2010",
"LastUpdateDate": "09/16/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GAVIN",
"AuthorizedOfficialFirstName": "GREG",
"AuthorizedOfficialMiddleName": "J.",
"AuthorizedOfficialTitle": "NETWORK ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "318-212-4232",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207T00000X",
"TaxonomyName": "Neurological Surgery Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}