{
"Npi": {
"NPI": "1235218959",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "ARC OF VIGO COUNTY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "89 CHERRY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TERRE HAUTE",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "47807-2942",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "812-232-4112",
"MailingAddressFaxNumber": "812-232-3052",
"FirstLinePracticeLocationAddress": "89 CHERRY ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TERRE HAUTE",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "47807-2942",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "812-232-4112",
"PracticeLocationAddressFaxNumber": "812-232-3052",
"EnumerationDate": "11/03/2006",
"LastUpdateDate": "09/06/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOLDNER",
"AuthorizedOfficialFirstName": "KIMBERLY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "812-232-4112",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302F00000X",
"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}