1396714101 NPI number — LIFECARE MEDICAL TRANSPORTS, LLC

Table of content: (NPI 1396714101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396714101 NPI number — LIFECARE MEDICAL TRANSPORTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFECARE MEDICAL TRANSPORTS, 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:
6
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:
1396714101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7152
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAROL STREAM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60197-7152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-597-4911
Provider Business Mailing Address Fax Number:
866-687-2796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1170 INTERNATIONAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22406-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-752-7721
Provider Business Practice Location Address Fax Number:
540-752-5194
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JEWELL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CHIEF REVENUE INTEGRATION OFFICER
Authorized Official Telephone Number:
844-597-4911

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  00749 , 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: 020215 . This is a "BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009010068 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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