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General NPI Number Information
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NPI Number | 1164025045
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Entity Type | Organization
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Legal Business Name | LIFECARE AMBULANCE OF MISSISSIPPI LLC
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Dates
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Enumeration Date | 11/21/2020
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Last Update Date | 11/21/2020
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Provider Practice Location Address
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Address Line | 10060 HIGHWAY 178 UNIT 600
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-3271
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Country | US
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Telephone | 901-372-0200
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Fax | 901-372-0170
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Provider Business Mailing Address
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Address Line | 3737 CHASE AVE
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City | SKOKIE
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State | IL
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Zip | 60076-4008
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Country | US
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Telephone | 847-933-9348
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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. JOHN J HERLIHY
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Credential |
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Telephone | 847-933-9348
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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 |
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License Number State |
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