MEDICARE: LIFE FIRST AMBULANCE DISTRICT

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

General Provider Information

NPI Number	:	1306505276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE FIRST AMBULANCE DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 21727
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44121-0727
Country	:	US
Telephone Number	:	440-605-9117
Fax Number	:	440-442-4443

Provider Business Practice Location Address
First Line	:	4628 LIBERTY STREET
Second Line	:
City	:	SULPHUR SPRINGS
State	:	OH
Zip	:	44881
Country	:	US
Telephone Number	:	419-569-3619
Fax Number	:

Authorized Official
Title or Position	:	FISCAL OFFIER/HR COORDINATOR
Name	:	STACEY SUTHERLAND
Credential	:
Telephone Number	:	419-569-3619

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	04/05/2023

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Directions to “LIFE FIRST AMBULANCE DISTRICT ” Practice Location

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