Healthcare Provider Details

I. General information

NPI: 1578637765
Provider Name (Legal Business Name): LIFELINE MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LEE HIGHWAY
CHILHOWIE VA
24319
US

IV. Provider business mailing address

PO BOX 1370 116 WEST LEE HIGHWAY
CHILHOWIE VA
24319-1370
US

V. Phone/Fax

Practice location:
  • Phone: 276-646-5030
  • Fax: 276-646-2223
Mailing address:
  • Phone: 276-646-5030
  • Fax: 276-646-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0206008393
License Number StateVA

VIII. Authorized Official

Name: MRS. KARLA LITTLE CAMPBELL
Title or Position: VP
Credential:
Phone: 276-646-5030