{
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"EIN": null,
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"FirstLineMailingAddress": "PO BOX 216",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WILLOW STREET",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17584-0216",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "717-464-2751",
"MailingAddressFaxNumber": "717-464-7261",
"FirstLinePracticeLocationAddress": "2600 WILLOW STREET PIKE S",
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"PracticeLocationAddressCityName": "WILLOW STREET",
"PracticeLocationAddressStateName": "PA",
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"PracticeLocationAddressTelephoneNumber": "717-464-2751",
"PracticeLocationAddressFaxNumber": "717-464-7261",
"EnumerationDate": "01/09/2008",
"LastUpdateDate": "04/13/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FLINCHBAUGH",
"AuthorizedOfficialFirstName": "KENT",
"AuthorizedOfficialMiddleName": "V.",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "717-464-2751",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213E00000X",
"TaxonomyName": "Podiatrist",
"LicenseNumber": "SC002310L",
"LicenseNumberStateCode": "PA",
"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."
}
}
}
}