MEDICARE: LIFEGUARD AMBULANCE SERVICE LLC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386188829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEGUARD AMBULANCE SERVICE LLC

Provider Business Mailing Address
First Line	:	PO BOX 847925
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7925
Country	:	US
Telephone Number	:	800-913-9106
Fax Number	:	330-384-4019

Provider Business Practice Location Address
First Line	:	118 N KANSAS ST
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096-5442
Country	:	US
Telephone Number	:	580-772-7971
Fax Number	:

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	TIMOTHY JOSEPH DORN
Credential	:
Telephone Number	:	833-703-2294

Provider Enumeration Date	:	12/16/2016
Last Update Date	:	09/15/2025

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