Healthcare Provider Details

I. General information

NPI: 1407615545
Provider Name (Legal Business Name): HEART LIFELINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 NE 28TH ST STE 107
OKLAHOMA CITY OK
73105-2822
US

IV. Provider business mailing address

1919 E 2ND ST # UNITE302
EDMOND OK
73034-6219
US

V. Phone/Fax

Practice location:
  • Phone: 682-847-1407
  • Fax:
Mailing address:
  • Phone: 682-847-1407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DELILAH NSUME ESAMA
Title or Position: CEO
Credential: LAB SUPPORT TECH
Phone: 682-847-1407