Healthcare Provider Details

I. General information

NPI: 1740577550
Provider Name (Legal Business Name): LIFEFLEET SOUTHEAST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MAIN ST
AUBURNDALE FL
33823-4113
US

IV. Provider business mailing address

PO BOX 402079
ATLANTA GA
30384-2079
US

V. Phone/Fax

Practice location:
  • Phone: 813-885-3955
  • Fax: 813-885-5844
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY DORN
Title or Position: CFO
Credential:
Phone: 303-495-1517