{
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"EIN": null,
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"NamePrefix": null,
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"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 44",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TIPPECANOE",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "46570-0044",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "574-498-6634",
"MailingAddressFaxNumber": "574-498-6634",
"FirstLinePracticeLocationAddress": "18331 STATE ROAD 331",
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"PracticeLocationAddressCityName": "TIPPECANOE",
"PracticeLocationAddressStateName": "IN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "574-498-6634",
"PracticeLocationAddressFaxNumber": "574-498-6634",
"EnumerationDate": "08/11/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IRONS",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "EARL",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "574-498-6484",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Land Ambulance",
"LicenseNumber": "50248",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}