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General NPI Number Information
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NPI Number | 1871592139
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Entity Type | Organization
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Legal Business Name | LIFEGUARD AMBULANCE SERVICE OF TENNESSEE LLC
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 1933 ELM TREE DR
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City | NASHVILLE
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State | TN
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Zip | 37210-3717
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Country | US
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Telephone | 615-724-1911
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Fax | 615-724-1048
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Provider Business Mailing Address
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Address Line | P.O. BOX 11361
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City | BIRMINGHAM
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State | AL
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Zip | 35202-1361
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Country | US
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Telephone | 205-380-2065
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Fax | 205-380-2074
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Authorized Official
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Title or Position | CEO PRESIDENT
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Name | MR. JOHN W ROCHE
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Credential |
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Telephone | 205-380-2065
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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 | EMS0000010028
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License Number State | TN
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