Healthcare Provider Details

I. General information

NPI: 1962945543
Provider Name (Legal Business Name): LIFENET, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

PO BOX 713383
CINCINNATI OH
45271-3383
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 Number510092
License Number StateMO

VIII. Authorized Official

Name: MATTHEW D SMITH
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 888-636-4438