{
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"EIN": null,
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"ParentOrgLBN": null,
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"OrgName": "VILLAGE OF MARYVILLE",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "2520 N CENTER ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MARYVILLE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62062-5671",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "800-962-1484",
"MailingAddressFaxNumber": "513-772-4464",
"FirstLinePracticeLocationAddress": "300 N DONK AVE",
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"PracticeLocationAddressCityName": "MARYVILLE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62062-2041",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "618-344-8099",
"PracticeLocationAddressFaxNumber": "618-344-2990",
"EnumerationDate": "05/27/2006",
"LastUpdateDate": "07/23/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DANKENBRING",
"AuthorizedOfficialFirstName": "DOUGLAS",
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"AuthorizedOfficialTitle": "FIRE CHIEF",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "618-344-8099",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": "4 4868",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}