{
"Npi": {
"NPI": "1891184123",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRIDEMARK EMS, INC",
"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": "104 N WHALEY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OPP",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "36467-2142",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "334-493-0299",
"MailingAddressFaxNumber": "334-493-0299",
"FirstLinePracticeLocationAddress": "104 N WHALEY ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OPP",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "36467-2142",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "334-493-0299",
"PracticeLocationAddressFaxNumber": "334-493-0299",
"EnumerationDate": "01/09/2015",
"LastUpdateDate": "01/09/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARCOTTE",
"AuthorizedOfficialFirstName": "NICHOLAS",
"AuthorizedOfficialMiddleName": "P",
"AuthorizedOfficialTitle": "CFO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "3348508556240",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}