Provider Demographics
NPI:1164847539
Name:LIFE MEDICAL RESPONSE, INC.
Entity Type:Organization
Organization Name:LIFE MEDICAL RESPONSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:PISTOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-354-3377
Mailing Address - Street 1:1643 OFFNERE ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3537
Mailing Address - Country:US
Mailing Address - Phone:740-354-3377
Mailing Address - Fax:740-354-3388
Practice Address - Street 1:1643 OFFNERE ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3537
Practice Address - Country:US
Practice Address - Phone:740-354-3377
Practice Address - Fax:740-354-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH730522341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance