{
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"EIN": null,
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"OrgName": "JEFFERSON HEADACHE CENTER",
"LastName": null,
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"FirstLineMailingAddress": "111 S 11TH ST",
"SecondLineMailingAddress": "SUITE 8130 GIBBON BUILDING",
"MailingAddressCityName": "PHILADELPHIA",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19107-4824",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "215-955-2727",
"MailingAddressFaxNumber": "215-955-6682",
"FirstLinePracticeLocationAddress": "111 S 11TH ST",
"SecondLinePracticeLocationAddress": "SUITE 8130 GIBBON BUILDING",
"PracticeLocationAddressCityName": "PHILADELPHIA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "215-955-2727",
"PracticeLocationAddressFaxNumber": "215-955-6682",
"EnumerationDate": "09/21/2009",
"LastUpdateDate": "09/21/2009",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GUILD",
"AuthorizedOfficialFirstName": "PATRICE",
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"AuthorizedOfficialCredential": "DIRECTOR, OPERATIONS",
"AuthorizedOfficialTelephoneNumber": "215-955-2212",
"Taxonomies": {
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"TaxonomyName": "General Acute Care Hospital",
"LicenseNumber": "438132",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}