{
"Npi": {
"NPI": "1992290647",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PACK MACHINE INCORPORATED",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "307 W SAINT PAUL ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SPRING VALLEY",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61362-1860",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "312-315-6584",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "307 W SAINT PAUL ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SPRING VALLEY",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "61362-1860",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "312-315-6584",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/26/2018",
"LastUpdateDate": "06/26/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BARRIOS",
"AuthorizedOfficialFirstName": "EDGAR",
"AuthorizedOfficialMiddleName": "ALEXANDER",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PEDORTHIST",
"AuthorizedOfficialTelephoneNumber": "312-315-6584",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332BC3200X",
"TaxonomyName": "Customized Equipment (DME)",
"LicenseNumber": "212000132",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}