{
"Npi": {
"NPI": "1891735866",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTHERN OKLAHOMA AMBULANCE SERVICE, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "517 GRAND AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ARDMORE",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73401-4338",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "580-223-1226",
"MailingAddressFaxNumber": "580-226-7154",
"FirstLinePracticeLocationAddress": "517 GRAND AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ARDMORE",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "73401-4338",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "580-223-1226",
"PracticeLocationAddressFaxNumber": "580-226-7154",
"EnumerationDate": "06/07/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARGIS",
"AuthorizedOfficialFirstName": "BOB",
"AuthorizedOfficialMiddleName": "W.",
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CCEMT-P",
"AuthorizedOfficialTelephoneNumber": "580-223-1226",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": "EMS064",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}