{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "PREMIUM MEDICAL TRANSPORTATION INC.",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "606 BLACKSHAW LN",
"SecondLineMailingAddress": "APT-23",
"MailingAddressCityName": "SAN YSIDRO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92173-4503",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-662-0563",
"MailingAddressFaxNumber": "619-662-0567",
"FirstLinePracticeLocationAddress": "270 E DOUGLAS AVE",
"SecondLinePracticeLocationAddress": "101",
"PracticeLocationAddressCityName": "EL CAJON",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92020-4514",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-662-0563",
"PracticeLocationAddressFaxNumber": "619-662-0567",
"EnumerationDate": "01/25/2011",
"LastUpdateDate": "02/12/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHAVEZ",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "619-765-6184",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "343900000X",
"TaxonomyName": "Non-emergency Medical Transport (VAN)",
"LicenseNumber": "N468",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}