1871592139 NPI number — LIFEGUARD AMBULANCE SERVICE OF TENNESSEE LLC

Table of content: (NPI 1871592139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871592139 NPI number — LIFEGUARD AMBULANCE SERVICE OF TENNESSEE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEGUARD AMBULANCE SERVICE OF TENNESSEE LLC
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:
1871592139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 11361
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35202-1361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-380-2065
Provider Business Mailing Address Fax Number:
205-380-2074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1933 ELM TREE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37210-3717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-724-1911
Provider Business Practice Location Address Fax Number:
615-724-1048
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROCHE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CEO PRESIDENT
Authorized Official Telephone Number:
205-380-2065

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  EMS0000010028 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3574708 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com