Healthcare Provider Details

I. General information

NPI: 1649820937
Provider Name (Legal Business Name): LIFEGUARD AMBULANCE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 MEDICAL CENTER DR
GAFFNEY SC
29340-4823
US

IV. Provider business mailing address

PO BOX 198408
ATLANTA GA
30384-8408
US

V. Phone/Fax

Practice location:
  • Phone: 864-720-6884
  • Fax:
Mailing address:
  • Phone: 800-913-9106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERIC THOMAS
Title or Position: SVP OF REVENUE MANAGEMENT
Credential:
Phone: 833-703-2294