1225030869 NPI number — LIFETEAM EMS INC

Table of content: (NPI 1225030869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225030869 NPI number — LIFETEAM EMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFETEAM EMS 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:
1225030869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7100 WHIPPLE AVE NW
Provider Second Line Business Mailing Address:
STE E
Provider Business Mailing Address City Name:
NORTH CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44720-7167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-386-5606
Provider Business Mailing Address Fax Number:
330-232-9917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7100 WHIPPLE AVE NW
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
NORTH CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44720-7167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-386-5606
Provider Business Practice Location Address Fax Number:
330-232-9917
Provider Enumeration Date:
08/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOSEPH
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
330-323-4800

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  150012 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1041716 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590004050 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0144560000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0668013 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013108 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0083370 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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