{
"Npi": {
"NPI": "1255786489",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DEACONESS REGIONAL HEALTHCARE SERVICES ILLINOIS INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "600 MARY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EVANSVILLE",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "47710-1658",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "618-252-9282",
"MailingAddressFaxNumber": "580-628-2267",
"FirstLinePracticeLocationAddress": "12 DR. WARREN TUTTLE DRIVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HARRISBURG",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62946",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "270-826-6558",
"PracticeLocationAddressFaxNumber": "270-826-6362",
"EnumerationDate": "04/25/2016",
"LastUpdateDate": "01/07/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FLORENCE",
"AuthorizedOfficialFirstName": "MARC",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "812-450-2552",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": "5235",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}