{
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"OrgName": "CITY OF COLLEYVILLE",
"LastName": null,
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"FirstLineMailingAddress": "5209 COLLEYVILLE BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLLEYVILLE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76034-5830",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-581-4591",
"MailingAddressFaxNumber": "817-581-4538",
"FirstLinePracticeLocationAddress": "5209 COLLEYVILLE BLVD",
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"PracticeLocationAddressCityName": "COLLEYVILLE",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-581-4591",
"PracticeLocationAddressFaxNumber": "817-581-4538",
"EnumerationDate": "07/26/2006",
"LastUpdateDate": "07/01/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CANTRELL",
"AuthorizedOfficialFirstName": "MARK",
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"AuthorizedOfficialTitle": "FIRE CHIEF",
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"AuthorizedOfficialTelephoneNumber": "940-390-7457",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Land Ambulance",
"LicenseNumber": "220006",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}