MEDICARE: LIFE LINE AMBULANCE SERVICE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance
2	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043214372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE LINE AMBULANCE SERVICE INC

Provider Business Mailing Address
First Line	:	PO BOX 847102
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7102
Country	:	US
Telephone Number	:	800-913-9106
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 HINMAN ST
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-1619
Country	:	US
Telephone Number	:	928-445-3814
Fax Number	:

Authorized Official
Title or Position	:	EVP, CHIEF FINANCIAL OFFICER
Name	:	BRIAN SCOTT TIERNEY
Credential	:
Telephone Number	:	833-703-2294

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/19/2026

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Directions to “LIFE LINE AMBULANCE SERVICE INC ” Practice Location

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