{
"Npi": {
"NPI": "1093890360",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "UPMC WILLIAMSPORT",
"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": "1205 GRAMPIAN BLVD",
"SecondLineMailingAddress": "2ND FLOOR",
"MailingAddressCityName": "WILLIAMSPORT",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17701-1978",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "570-326-8676",
"MailingAddressFaxNumber": "570-326-8601",
"FirstLinePracticeLocationAddress": "777 RURAL AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WILLIAMSPORT",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "17701-3109",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "570-321-1000",
"PracticeLocationAddressFaxNumber": "570-326-8601",
"EnumerationDate": "10/26/2006",
"LastUpdateDate": "02/27/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SANTANGELO",
"AuthorizedOfficialFirstName": "CHARLES",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "EXECUTIVE VP CFO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CPA FHFMA",
"AuthorizedOfficialTelephoneNumber": "570-321-3171",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": "234601",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}