{
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"FirstLineMailingAddress": "PO BOX 2777",
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"MailingAddressCityName": "BOISE",
"MailingAddressStateName": "ID",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-706-5000",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1000 STATE ST",
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"PracticeLocationAddressCityName": "MCCALL",
"PracticeLocationAddressStateName": "ID",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/23/2010",
"LastUpdateDate": "12/08/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FOWLER",
"AuthorizedOfficialFirstName": "KATHRYN",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "208-381-8717",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Medicare Defined Swing Bed Hospital Unit",
"LicenseNumber": "11",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}