{
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"EIN": null,
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"IsOrgSubpart": "N",
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"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1233",
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"MailingAddressCityName": "GLENWOOD",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "71943-1233",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "870-356-2010",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "115 NORTH 3RD. ST.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GLENWOOD",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "71943-9247",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "870-356-2010",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/30/2013",
"LastUpdateDate": "05/30/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PATE",
"AuthorizedOfficialFirstName": "RYAN",
"AuthorizedOfficialMiddleName": "NEAL",
"AuthorizedOfficialTitle": "DIRECTOR/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PARAMEDIC",
"AuthorizedOfficialTelephoneNumber": "870-557-4429",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "341600000X",
"TaxonomyName": "Ambulance",
"LicenseNumber": "807",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}