=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912972928
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFEFLEET LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2006
-----------------------------------------------------
Last Update Date | 12/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11000 MARKET ST
-----------------------------------------------------
City | NORTH LIMA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44452-9775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-549-9739
-----------------------------------------------------
Fax | 330-549-9741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 390
-----------------------------------------------------
City | NORTH LIMA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44452-0390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-549-9739
-----------------------------------------------------
Fax | 330-549-9741
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JEFF LOWERY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-518-5253
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 500242
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------