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General NPI Number Information
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NPI Number | 1407615545
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Entity Type | Organization
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Legal Business Name | HEART LIFELINE LLC
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Dates
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Enumeration Date | 03/18/2024
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 312 NE 28TH ST STE 107
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City | OKLAHOMA CITY
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State | OK
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Zip | 73105-2822
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Country | US
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Telephone | 682-847-1407
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 E 2ND ST # UNITE302
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City | EDMOND
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State | OK
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Zip | 73034-6219
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Country | US
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Telephone | 682-847-1407
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DELILAH NSUME ESAMA
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Credential | LAB SUPPORT TECH
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Telephone | 682-847-1407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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