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General NPI Number Information
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NPI Number | 1801255849
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Entity Type | Organization
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Legal Business Name | LIFENET, INC.
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 12866 TROXLER AVE
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City | HIGHLAND
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State | IL
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Zip | 62249-2806
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Country | US
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Telephone | 888-636-4438
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 713362
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City | CINCINNATI
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State | OH
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Zip | 45271-3362
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Country | US
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Telephone | 888-636-4438
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT - PBS
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Name | MARK RAYMOND KEENE
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Credential |
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Telephone | 888-636-4438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416A0800X
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Taxonomy Name | Air Ambulance
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License Number | 04 486012
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License Number State | IL
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