MEDICARE: TEXAS LIFELINE CORPORATION OF LIVE OAK CO.

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	300273	TX

General Provider Information

NPI Number	:	1689688517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS LIFELINE CORPORATION OF LIVE OAK CO.

Provider Business Mailing Address
First Line	:	PO BOX 571909
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75357-1909
Country	:	US
Telephone Number	:	214-327-8222
Fax Number	:	214-388-2093

Provider Business Practice Location Address
First Line	:	5409 N JIM MILLER RD
Second Line	:	SUITE 203A
City	:	DALLAS
State	:	TX
Zip	:	75227-1542
Country	:	US
Telephone Number	:	214-327-8222
Fax Number	:	214-388-2093

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. DARRYL QUIGLEY
Credential	:
Telephone Number	:	214-327-8222

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/22/2020

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