{
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"FirstLineMailingAddress": "PO BOX 429",
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"MailingAddressCityName": "LEWISVILLE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27023-0429",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "734-224-4474",
"MailingAddressFaxNumber": "336-791-0196",
"FirstLinePracticeLocationAddress": "398 W 700 N",
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"PracticeLocationAddressCityName": "VALPARAISO",
"PracticeLocationAddressStateName": "IN",
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"PracticeLocationAddressTelephoneNumber": "219-759-3919",
"PracticeLocationAddressFaxNumber": "219-759-8068",
"EnumerationDate": "05/16/2006",
"LastUpdateDate": "08/04/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLANCY",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "219-762-1623",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Ambulance",
"LicenseNumber": "0067",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}