Provider Demographics
NPI:1225476021
Name:LIFELINE MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:LIFELINE MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-388-6615
Mailing Address - Street 1:PO BOX 37291
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-7291
Mailing Address - Country:US
Mailing Address - Phone:602-758-3580
Mailing Address - Fax:602-325-4085
Practice Address - Street 1:5314 W GRENADINE RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2416
Practice Address - Country:US
Practice Address - Phone:602-758-9580
Practice Address - Fax:602-325-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ807233343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)