{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "RIVER SOURCE TRANSPORTATION",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7800 METRO PKWY",
"SecondLineMailingAddress": "#300",
"MailingAddressCityName": "BLOOMINGTON",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55425-1514",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "952-223-3773",
"MailingAddressFaxNumber": "952-955-4395",
"FirstLinePracticeLocationAddress": "7800 METRO PKWY",
"SecondLinePracticeLocationAddress": "#300",
"PracticeLocationAddressCityName": "BLOOMINGTON",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "952-223-3773",
"PracticeLocationAddressFaxNumber": "952-955-4395",
"EnumerationDate": "04/20/2017",
"LastUpdateDate": "04/20/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABABIO",
"AuthorizedOfficialFirstName": "VICTOR",
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"AuthorizedOfficialCredential": "MANAGER",
"AuthorizedOfficialTelephoneNumber": "952-223-3773",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "343900000X",
"TaxonomyName": "Non-emergency Medical Transport (VAN)",
"LicenseNumber": "382309",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}