{
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"OrgName": "SUPERIOR VOLUNTEER FIRE COMPANY INC",
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"FirstLineMailingAddress": "1940 S BONITO WAY STE 190",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MERIDIAN",
"MailingAddressStateName": "ID",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-287-9420",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1202 5TH AVE E.",
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"PracticeLocationAddressCityName": "SUPERIOR",
"PracticeLocationAddressStateName": "MT",
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"PracticeLocationAddressTelephoneNumber": "406-822-3570",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/06/2006",
"LastUpdateDate": "03/14/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "METZGER",
"AuthorizedOfficialFirstName": "PATRICK",
"AuthorizedOfficialMiddleName": "ALAN",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "406-822-3001",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Land Ambulance",
"LicenseNumber": "92",
"LicenseNumberStateCode": "MT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}