MEDICARE: LIFEGUARD AMBULANCE SERVICE OF TENNESSEE 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	EMS0000010028	TN

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	:	1871592139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEGUARD AMBULANCE SERVICE OF TENNESSEE LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 11361
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35202-1361
Country	:	US
Telephone Number	:	205-380-2065
Fax Number	:	205-380-2074

Provider Business Practice Location Address
First Line	:	1933 ELM TREE DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37210-3717
Country	:	US
Telephone Number	:	615-724-1911
Fax Number	:	615-724-1048

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	MR. JOHN W ROCHE
Credential	:
Telephone Number	:	205-380-2065

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	11/10/2010

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