{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "TIPPECANOE EMERGENCY AMBULANCE SERVICE",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 5477",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAFAYETTE",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "47903-5477",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "765-423-6235",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1501 HARTFORD ST",
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"PracticeLocationAddressCityName": "LAFAYETTE",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "47904-2134",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "765-423-6235",
"PracticeLocationAddressFaxNumber": "765-423-6049",
"EnumerationDate": "12/13/2005",
"LastUpdateDate": "05/29/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BORCK",
"AuthorizedOfficialFirstName": "ALLEN",
"AuthorizedOfficialMiddleName": "L.",
"AuthorizedOfficialTitle": "CEO",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "765-423-6235",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": "0007",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}