Healthcare Provider Details

I. General information

NPI: 1295881985
Provider Name (Legal Business Name): LIFELINE PARAMEDICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 INDUSTRIAL DR
HARRISBURG AR
72432-8043
US

IV. Provider business mailing address

1500 INDUSTRIAL DR
HARRISBURG AR
72432-8043
US

V. Phone/Fax

Practice location:
  • Phone: 870-578-5441
  • Fax: 870-578-2172
Mailing address:
  • Phone: 870-578-5441
  • Fax: 870-578-2172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number624
License Number StateAR

VIII. Authorized Official

Name: MRS. LORI L DAVIS
Title or Position: OWNER
Credential:
Phone: 870-578-5640