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General NPI Number Information
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NPI Number | 1114091147
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Entity Type | Organization
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Legal Business Name | LIFELINE EMS LLC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 146 DR. HERD E. STONE
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City | HOLLY GROVE
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State | AR
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Zip | 72069
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Country | US
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Telephone | 870-462-8003
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 592
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City | HOLLY GROVE
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State | AR
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Zip | 72069-0592
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Country | US
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Telephone | 870-462-8003
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DAVID DONOVAN
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Credential |
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Telephone | 870-462-8003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 319
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License Number State | AR
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