{
"Npi": {
"NPI": "1174705859",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LIFELINE EMS LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "510 E JACKSON AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WEST MEMPHIS",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72301-4336",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "870-735-9718",
"MailingAddressFaxNumber": "870-735-9718",
"FirstLinePracticeLocationAddress": "510 E JACKSON AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WEST MEMPHIS",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72301-4336",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "870-735-9718",
"PracticeLocationAddressFaxNumber": "870-735-9718",
"EnumerationDate": "12/04/2007",
"LastUpdateDate": "06/22/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TACITO",
"AuthorizedOfficialFirstName": "CHARLIE",
"AuthorizedOfficialMiddleName": "ANDREW",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "EMT",
"AuthorizedOfficialTelephoneNumber": "901-619-3127",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": "0000010018",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}