Provider Demographics
NPI:1235434853
Name:LIFELINE AMBULANCE
Entity Type:Organization
Organization Name:LIFELINE AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-243-4444
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-0206
Mailing Address - Country:US
Mailing Address - Phone:803-243-4444
Mailing Address - Fax:
Practice Address - Street 1:106 CALEDONIA CT
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-9707
Practice Address - Country:US
Practice Address - Phone:803-243-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFELINE AMBULANCE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance