{
"Npi": {
"NPI": "1871710863",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "UNITY POINT CC SCHOOL DIST 140",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4033 S ILLINOIS AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CARBONDALE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62903-8375",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "618-529-4151",
"MailingAddressFaxNumber": "618-529-4154",
"FirstLinePracticeLocationAddress": "4033 S ILLINOIS AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CARBONDALE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62903-8375",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "618-529-4151",
"PracticeLocationAddressFaxNumber": "618-529-4154",
"EnumerationDate": "04/19/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LASER",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "ACCOUNTANT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "618-529-4151",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QS1000X",
"TaxonomyName": "Student Health Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}