{
"Npi": {
"NPI": "1962538900",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COMMUNITY AMBULANCE SERVICE CLUB",
"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 33",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TOWER CITY",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17980-0033",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "717-647-2271",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "633 EAST COLLIERY AVENUE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TOWER CITY",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "17980",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "717-943-8013",
"PracticeLocationAddressFaxNumber": "717-647-2546",
"EnumerationDate": "02/26/2007",
"LastUpdateDate": "09/15/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEITER",
"AuthorizedOfficialFirstName": "JEREMIAH",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "717-943-8013",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": "04141",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}