1205828779 NPI number — LIFECARE AMBULANCE SERVICE, INC.

Table of content: (NPI 1205828779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205828779 NPI number — LIFECARE AMBULANCE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFECARE AMBULANCE SERVICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205828779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1069
Provider Second Line Business Mailing Address:
1728 NORTON ROAD SW
Provider Business Mailing Address City Name:
WISE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24293-1069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-679-4375
Provider Business Mailing Address Fax Number:
276-679-2866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1728 NORTON ROAD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WISE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24293-1069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-679-4375
Provider Business Practice Location Address Fax Number:
276-679-2866
Provider Enumeration Date:
08/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CARICO
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ADMINISTRATIVE ASSISTANT
Authorized Official Telephone Number:
276-679-4375

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  470 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ANTHEM . This is a "096163" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com