{
"Npi": {
"NPI": "1891126652",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COASTAL LIFE AMBULANCE, INC.",
"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": "PO BOX 487",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WALTERBORO",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29488-0005",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-935-5525",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "415 ROBERTSON BLVD STE B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WALTERBORO",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29488-5713",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "888-935-5525",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/04/2013",
"LastUpdateDate": "05/04/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRUSSEAU",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": "CLAIR",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "II",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "916-871-8487",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}