Provider Demographics
NPI:1306180054
Name:LIFENET
Entity Type:Organization
Organization Name:LIFENET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MULVANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-221-5433
Mailing Address - Street 1:9708 SKILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5150
Mailing Address - Country:US
Mailing Address - Phone:214-221-5433
Mailing Address - Fax:214-932-1977
Practice Address - Street 1:9708 SKILLMAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5150
Practice Address - Country:US
Practice Address - Phone:214-221-5433
Practice Address - Fax:214-932-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization