{
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"OrgName": "CARESOURCE TRANSPORTATION, LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2117 CRESENT LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOUTHAVEN",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "38672-8321",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-330-0073",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "210 ALCORN DR",
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"PracticeLocationAddressCityName": "CORINTH",
"PracticeLocationAddressStateName": "MS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "630-330-0073",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/16/2016",
"LastUpdateDate": "08/16/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHITE",
"AuthorizedOfficialFirstName": "CHRISTOPHER",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "630-330-0073",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": "904, ALCORN",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}