1558674895 NPI number — LIFE-FORCE AMBULANCE, INC

Table of content: (NPI 1558674895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558674895 NPI number — LIFE-FORCE AMBULANCE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE-FORCE AMBULANCE, 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:
LIFE-FORCE AMBULANCE
Provider Other Organization Name Type Code:
3
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:
1558674895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 W I PKWY
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30132-5066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-363-3622
Provider Business Mailing Address Fax Number:
678-363-5929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W I PKWY
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30132-5066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-363-3622
Provider Business Practice Location Address Fax Number:
678-363-5929
Provider Enumeration Date:
07/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BURGESS
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
CARROLL
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
770-853-6453

Provider Taxonomy Codes

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

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





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