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General NPI Number Information
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NPI Number | 1487607727
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Entity Type | Organization
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Legal Business Name | LIFE AMBULANCE SERVICE INC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 1641 OFFNERE ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-3537
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Country | US
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Telephone | 740-353-7725
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Fax | 740-354-1859
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Provider Business Mailing Address
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Address Line | 1641 OFFNERE ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-3537
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Country | US
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Telephone | 740-353-7725
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Fax | 740-354-1859
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Authorized Official
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Title or Position | BILLING DEPARTMENT MANAGER
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Name | CAROL DEATERLA
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Credential |
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Telephone | 740-353-7725
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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 | 730012
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License Number State | OH
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