{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "SPIRIT PHYSICIAN SERVICES, INC",
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"NameSuffix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "423 N 21ST ST",
"SecondLineMailingAddress": "SUITE 202",
"MailingAddressCityName": "CAMP HILL",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17011-2207",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "717-763-9880",
"MailingAddressFaxNumber": "717-737-2765",
"FirstLinePracticeLocationAddress": "423 N 21ST ST",
"SecondLinePracticeLocationAddress": "SUITE 202",
"PracticeLocationAddressCityName": "CAMP HILL",
"PracticeLocationAddressStateName": "PA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "717-763-9880",
"PracticeLocationAddressFaxNumber": "717-737-2765",
"EnumerationDate": "11/17/2008",
"LastUpdateDate": "11/17/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OSMAN",
"AuthorizedOfficialFirstName": "GERALD",
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"AuthorizedOfficialTitle": "VICE-PRESIDENT, COO",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "717-972-4480",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LX0001X",
"TaxonomyName": "Obstetrics & Gynecology Nurse Practitioner",
"LicenseNumber": "SP009550",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}