Provider Demographics
NPI:1114113255
Name:LIFE LINE EMERGENCY SERVICES LLC
Entity Type:Organization
Organization Name:LIFE LINE EMERGENCY SERVICES LLC
Other - Org Name:LIFE LINE EMS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-773-3522
Mailing Address - Street 1:2626 S. LOOP WEST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-5613
Mailing Address - Country:US
Mailing Address - Phone:713-669-1090
Mailing Address - Fax:713-669-1091
Practice Address - Street 1:8700 COMMERCE PARK DR
Practice Address - Street 2:STE 214
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7497
Practice Address - Country:US
Practice Address - Phone:713-773-3522
Practice Address - Fax:713-776-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-22
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000067341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB928OtherBCBS OF TEXAS
TXAMB928OtherBCBS OF TEXAS