MEDICARE: LIFE 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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1891385191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE AMBULANCE SERVICE INC.

Provider Business Mailing Address
First Line	:	PO BOX 26486
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79926-6486
Country	:	US
Telephone Number	:	915-772-1642
Fax Number	:

Provider Business Practice Location Address
First Line	:	5720 TROWBRIDGE DR STE B
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-3358
Country	:	US
Telephone Number	:	915-772-1642
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RACHEL BURCH HARRACKSINGH
Credential	:
Telephone Number	:	915-772-1642

Provider Enumeration Date	:	01/20/2021
Last Update Date	:	01/20/2021

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