{
"Npi": {
"NPI": "1508965534",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "PERRY COUNTY HEALTH SYSTEM",
"ParentOrgTIN": null,
"OrgName": "PERRYVILLE HEALTHCARE CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "212 HOSPITAL LN",
"SecondLineMailingAddress": "SUITE 102",
"MailingAddressCityName": "PERRYVILLE",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63775-1276",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "573-547-4960",
"MailingAddressFaxNumber": "573-547-6540",
"FirstLinePracticeLocationAddress": "212 HOSPITAL LN STE 102",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PERRYVILLE",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63775-4204",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "573-547-4960",
"PracticeLocationAddressFaxNumber": "573-547-6540",
"EnumerationDate": "09/22/2006",
"LastUpdateDate": "03/07/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COVER",
"AuthorizedOfficialFirstName": "DANA",
"AuthorizedOfficialMiddleName": "S.",
"AuthorizedOfficialTitle": "PHARMACIST IN CHARGE",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "RPH",
"AuthorizedOfficialTelephoneNumber": "573-547-4960",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "333600000X",
"TaxonomyName": "Pharmacy",
"LicenseNumber": "006636",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}