Provider Demographics
NPI:1023011392
Name:LIFELINE AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:LIFELINE AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:540-382-1813
Mailing Address - Street 1:310 BELL RD
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-2402
Mailing Address - Country:US
Mailing Address - Phone:540-381-7480
Mailing Address - Fax:540-381-7472
Practice Address - Street 1:310 BELL RD
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-2402
Practice Address - Country:US
Practice Address - Phone:540-381-7480
Practice Address - Fax:540-381-7472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA494341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9000038Medicaid
VA009000038Medicaid
VA590000064Medicare ID - Type Unspecified
VA9000038Medicaid
VA590000128Medicare ID - Type Unspecified