Healthcare Provider Details

I. General information

NPI: 1801255849
Provider Name (Legal Business Name): LIFENET, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12866 TROXLER AVE
HIGHLAND IL
62249-2806
US

IV. Provider business mailing address

PO BOX 713362
CINCINNATI OH
45271-3362
US

V. Phone/Fax

Practice location:
  • Phone: 888-636-4438
  • Fax:
Mailing address:
  • Phone: 888-636-4438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number04 486012
License Number StateIL

VIII. Authorized Official

Name: MARK RAYMOND KEENE
Title or Position: SENIOR VICE PRESIDENT - PBS
Credential:
Phone: 888-636-4438