{
"Npi": {
"NPI": "1902730575",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "SOUTHERN TIER COMMUNITY HEALTH CENTER NETWORK INC",
"ParentOrgTIN": null,
"OrgName": "SOUTHERN TIER COMMUNITY HEALTH CENTER NETWORK 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": "135 N UNION ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OLEAN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14760-2736",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "135 N UNION ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OLEAN",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14760-2736",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "716-375-7500",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/10/2026",
"LastUpdateDate": "06/10/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLAKE",
"AuthorizedOfficialFirstName": "ERIC",
"AuthorizedOfficialMiddleName": "B.",
"AuthorizedOfficialTitle": "CHIEF COMPLIANCE OFFICER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "740-454-2086",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}