=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043288624
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE LINE MEDICAL AMBULANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 CENTER STREET
-----------------------------------------------------
City | FULTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-864-3967
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 CENTER STREET PO BOX 97
-----------------------------------------------------
City | FULTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-864-3967
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARAMEDIC/PRESIDENT
-----------------------------------------------------
Name | MS. SHONA L SEARLS
-----------------------------------------------------
Credential | R.N., EMT-P
-----------------------------------------------------
Telephone | 419-864-3967
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 420022
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------