{
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"FirstLineMailingAddress": "200 S RIVER ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PLAINS",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "18705-1143",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "570-899-5605",
"MailingAddressFaxNumber": "570-821-1105",
"FirstLinePracticeLocationAddress": "200 S RIVER ST",
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"PracticeLocationAddressCityName": "PLAINS",
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"PracticeLocationAddressFaxNumber": "570-821-1105",
"EnumerationDate": "06/04/2013",
"LastUpdateDate": "06/04/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOBST",
"AuthorizedOfficialFirstName": "CHARLES",
"AuthorizedOfficialMiddleName": "A.",
"AuthorizedOfficialTitle": "CERTIFIED SURGICAL ASSISTANT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "III",
"AuthorizedOfficialCredential": "CSA",
"AuthorizedOfficialTelephoneNumber": "570-417-8831",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363AS0400X",
"TaxonomyName": "Surgical Physician Assistant",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}