Provider Demographics
NPI:1154849115
Name:LIFELINE AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:LIFELINE AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-585-3952
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-0444
Mailing Address - Country:US
Mailing Address - Phone:865-585-3952
Mailing Address - Fax:423-815-1509
Practice Address - Street 1:428 TOM BALL ROAD
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-2512
Practice Address - Country:US
Practice Address - Phone:865-585-3952
Practice Address - Fax:423-815-1509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport