{
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"EIN": null,
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"OrgName": "RIVER VALLEY FAMILY PRACTICE LTD",
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"FirstLineMailingAddress": "602 35TH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOLINE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61265-6145",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "309-736-4173",
"MailingAddressFaxNumber": "309-797-5653",
"FirstLinePracticeLocationAddress": "2550 24TH ST",
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"PracticeLocationAddressCityName": "ROCK ISLAND",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "61201-5304",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "309-793-4223",
"PracticeLocationAddressFaxNumber": "309-793-6276",
"EnumerationDate": "01/22/2007",
"LastUpdateDate": "10/11/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GANNON",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DOCTOR",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "309-739-4223",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}