{
"Npi": {
"NPI": "1225369069",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TRI STATE AMBULANCE INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2511 WAYNESBURG DR SE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CANTON",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44707-2063",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "330-484-8894",
"MailingAddressFaxNumber": "330-232-9917",
"FirstLinePracticeLocationAddress": "7100 WHIPPLE AVE NW STE C",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH CANTON",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44720-7167",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "330-478-4111",
"PracticeLocationAddressFaxNumber": "330-232-9917",
"EnumerationDate": "01/19/2010",
"LastUpdateDate": "12/21/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOSEPH",
"AuthorizedOfficialFirstName": "KENNETH",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "330-484-8894",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}