{
"Npi": {
"NPI": "1881906063",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TRI STAR AMBULANCE LLC",
"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": "5900 MAXHAM RD",
"SecondLineMailingAddress": "SUITE 13",
"MailingAddressCityName": "AUSTELL",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30168-4258",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "404-966-5553",
"MailingAddressFaxNumber": "770-745-6491",
"FirstLinePracticeLocationAddress": "5900 MAXHAM RD",
"SecondLinePracticeLocationAddress": "SUITE 13",
"PracticeLocationAddressCityName": "AUSTELL",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30168-4258",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "404-966-5553",
"PracticeLocationAddressFaxNumber": "770-745-6491",
"EnumerationDate": "07/05/2010",
"LastUpdateDate": "07/05/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABUKHALID",
"AuthorizedOfficialFirstName": "NAIEF",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "404-966-5553",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": "033-49",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}