{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "NORTH IDAHO IMMEDIATE CARE",
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"FirstLineMailingAddress": "927 E POLSTON AVE",
"SecondLineMailingAddress": "SUITE 303",
"MailingAddressCityName": "POST FALLS",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83854-9811",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-664-3313",
"MailingAddressFaxNumber": "208-664-2793",
"FirstLinePracticeLocationAddress": "750 N SYRINGA ST",
"SecondLinePracticeLocationAddress": "SUITE 100",
"PracticeLocationAddressCityName": "POST FALLS",
"PracticeLocationAddressStateName": "ID",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-664-3313",
"PracticeLocationAddressFaxNumber": "208-664-2793",
"EnumerationDate": "02/26/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARRIS",
"AuthorizedOfficialFirstName": "SHANNON",
"AuthorizedOfficialMiddleName": "K",
"AuthorizedOfficialTitle": "BUSINESS DIRECTOR",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "208-664-3313",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207PE0004X",
"TaxonomyName": "Emergency Medical Services (Emergency Medicine) Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}