{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "TRINITY AMBULANCE SERVICE, INC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "106 19TH AVE",
"SecondLineMailingAddress": "SUITE 102",
"MailingAddressCityName": "MOLINE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61265-3700",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "309-779-5642",
"MailingAddressFaxNumber": "309-779-5644",
"FirstLinePracticeLocationAddress": "8110 14TH ST W",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROCK ISLAND",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "61201-7601",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "309-787-1846",
"PracticeLocationAddressFaxNumber": "309-787-3795",
"EnumerationDate": "02/19/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KEARNS",
"AuthorizedOfficialFirstName": "RICH",
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"AuthorizedOfficialTitle": "DIRECTOR",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "309-787-3465",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "341600000X",
"TaxonomyName": "Ambulance",
"LicenseNumber": "22978",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}