Healthcare Provider Details

I. General information

NPI: 1386188829
Provider Name (Legal Business Name): LIFEGUARD AMBULANCE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 N KANSAS ST
WEATHERFORD OK
73096-5442
US

IV. Provider business mailing address

PO BOX 847925
DALLAS TX
75284-7925
US

V. Phone/Fax

Practice location:
  • Phone: 580-772-7971
  • Fax:
Mailing address:
  • Phone: 800-913-9106
  • Fax: 330-384-4019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIMOTHY JOSEPH DORN
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 833-703-2294