{
"Npi": {
"NPI": "1265016059",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DICKINSON COUNTY HEALTHCARE SYSTEM",
"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": "1000 N OAK AVE",
"SecondLineMailingAddress": "PROVIDER ENROLLMENT SVCS - SHP FL2",
"MailingAddressCityName": "MARSHFIELD",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54449-5703",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "715-387-0660",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1010 OLIVE AVE STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FLORENCE",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54121-2702",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "906-776-5615",
"PracticeLocationAddressFaxNumber": "906-776-5546",
"EnumerationDate": "05/08/2021",
"LastUpdateDate": "10/26/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRESSLER",
"AuthorizedOfficialFirstName": "KATHLEEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "COO, AO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "715-975-6018",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}