Provider Demographics
NPI:1043288624
Name:LIFE LINE MEDICAL AMBULANCE
Entity Type:Organization
Organization Name:LIFE LINE MEDICAL AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARAMEDIC/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHONA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEARLS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, EMT-P
Authorized Official - Phone:419-864-3967
Mailing Address - Street 1:200 CENTER STREET
Mailing Address - Street 2:PO BOX 97
Mailing Address - City:FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:43321
Mailing Address - Country:US
Mailing Address - Phone:419-864-3967
Mailing Address - Fax:
Practice Address - Street 1:200 CENTER STREET
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:OH
Practice Address - Zip Code:43321
Practice Address - Country:US
Practice Address - Phone:419-864-3967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH420022341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0213941Medicaid
OH0213941Medicaid