MEDICARE: LIFELINC ANESTHESIA, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist
2	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801021464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINC ANESTHESIA, PLLC

Provider Business Mailing Address
First Line	:	3340 PLAYERS CLUB PKWY
Second Line	:	SUITE 350
City	:	MEMPHIS
State	:	TN
Zip	:	38125-8933
Country	:	US
Telephone Number	:	901-207-2017
Fax Number	:	844-752-2163

Provider Business Practice Location Address
First Line	:	3340 PLAYERS CLUB PKWY STE 350
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-8949
Country	:	US
Telephone Number	:	901-207-2017
Fax Number	:	844-752-2163

Authorized Official
Title or Position	:	COO
Name	:	ERICA N WARREN
Credential	:	MHA
Telephone Number	:	901-207-2017

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	09/29/2020

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