{
"Npi": {
"NPI": "1114003795",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GRAND PORTAGE RESERVATION BUSINESS COMMITTEE",
"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": "62 UPPER RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRAND PORTAGE",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55605-3010",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "218-475-2235",
"MailingAddressFaxNumber": "218-475-2261",
"FirstLinePracticeLocationAddress": "62 UPPER RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRAND PORTAGE",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55605-3010",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "218-475-2235",
"PracticeLocationAddressFaxNumber": "218-475-2261",
"EnumerationDate": "10/27/2006",
"LastUpdateDate": "11/12/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DESCHAMPE",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CHAIRMAN",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "218-475-2277",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": "0321",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}