{
"Npi": {
"NPI": "1699853788",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BOYD EDSON DELMAR FD AMBULANCE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 177",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOYD",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54726",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "715-667-3255",
"MailingAddressFaxNumber": "715-667-3031",
"FirstLinePracticeLocationAddress": "100 S OSHKOSH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOYD",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54726",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "715-667-3255",
"PracticeLocationAddressFaxNumber": "715-667-3031",
"EnumerationDate": "11/02/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SUPPLE",
"AuthorizedOfficialFirstName": "FORREST",
"AuthorizedOfficialMiddleName": "EUGENE",
"AuthorizedOfficialTitle": "AMBULANCE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "715-667-3255",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "341600000X",
"TaxonomyName": "Ambulance",
"LicenseNumber": "6000352",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}