{
"Npi": {
"NPI": "1992976013",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SPIRIT PROSTHETICS",
"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": "4728 TILLERY RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KNOXVILLE",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37912-5400",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "865-363-3513",
"MailingAddressFaxNumber": "865-549-4598",
"FirstLinePracticeLocationAddress": "211 E BLOUNT AVE",
"SecondLinePracticeLocationAddress": "SUITE 701",
"PracticeLocationAddressCityName": "KNOXVILLE",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37920-1614",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "865-549-4599",
"PracticeLocationAddressFaxNumber": "865-549-4598",
"EnumerationDate": "03/17/2008",
"LastUpdateDate": "03/17/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOHNSON",
"AuthorizedOfficialFirstName": "BRIAN",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "OWNER/PROSTHETIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CP, LP",
"AuthorizedOfficialTelephoneNumber": "865-363-3513",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA0900X",
"TaxonomyName": "Amputee Clinic/Center",
"LicenseNumber": "PRO0000000113",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}