{
"Npi": {
"NPI": "1750566543",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DISTINCTIVE CARE TRANSPORTATION COMPANY",
"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 090374",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MILWAUKEE",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53209-0374",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "414-406-1438",
"MailingAddressFaxNumber": "414-353-5633",
"FirstLinePracticeLocationAddress": "6621 N YUBA ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MILWAUKEE",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53223-5759",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "414-406-1438",
"PracticeLocationAddressFaxNumber": "414-353-5633",
"EnumerationDate": "12/31/2007",
"LastUpdateDate": "12/31/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SAMUEL",
"AuthorizedOfficialFirstName": "KENNY",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "PARTNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "414-406-1438",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "343900000X",
"TaxonomyName": "Non-emergency Medical Transport (VAN)",
"LicenseNumber": "41488300",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}