{
"Npi": {
"NPI": "1992157697",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BROADWAY I-30 MEDICAL CLINIC, PLLC",
"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": "407 W INTERSTATE 30",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GARLAND",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75043-5912",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-240-8539",
"MailingAddressFaxNumber": "972-303-1994",
"FirstLinePracticeLocationAddress": "407 W INTERSTATE 30",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GARLAND",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75043-5912",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-240-8539",
"PracticeLocationAddressFaxNumber": "972-303-1994",
"EnumerationDate": "07/06/2016",
"LastUpdateDate": "07/06/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLARKE",
"AuthorizedOfficialFirstName": "CARLTON",
"AuthorizedOfficialMiddleName": "K",
"AuthorizedOfficialTitle": "MEDICAL DIRECTOR-OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "214-803-4516",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "F0154",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "207V00000X",
"TaxonomyName": "Obstetrics & Gynecology Physician",
"LicenseNumber": "L4890",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}