{
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"FirstLineMailingAddress": "PO BOX 7",
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"MailingAddressCityName": "ROBERTSDALE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "16674-0007",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "814-635-2495",
"MailingAddressFaxNumber": "814-635-4311",
"FirstLinePracticeLocationAddress": "6340 NEW GRENADA HWY",
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"PracticeLocationAddressCityName": "ROBERTSDALE",
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"PracticeLocationAddressTelephoneNumber": "814-635-2495",
"PracticeLocationAddressFaxNumber": "814-635-4311",
"EnumerationDate": "08/03/2005",
"LastUpdateDate": "12/30/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARTIN",
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"AuthorizedOfficialTelephoneNumber": "814-599-6594",
"Taxonomies": {
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"TaxonomyName": "Land Ambulance",
"LicenseNumber": "04078",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}