Healthcare Provider Details

I. General information

NPI: 1801704374
Provider Name (Legal Business Name): LIFELINE DISTRIBUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 DONOVAN DR
DUBUQUE IA
52002-2641
US

IV. Provider business mailing address

1616 DONOVAN DR
DUBUQUE IA
52002-2641
US

V. Phone/Fax

Practice location:
  • Phone: 563-663-1959
  • Fax:
Mailing address:
  • Phone: 563-663-1959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SIDRA ABBAS
Title or Position: OWNER
Credential:
Phone: 563-663-1959