Provider Demographics
NPI:1306829395
Name:MED LIFE EMER MED SVCS INC
Entity Type:Organization
Organization Name:MED LIFE EMER MED SVCS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-281-5433
Mailing Address - Street 1:1917 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-4069
Mailing Address - Country:US
Mailing Address - Phone:318-281-5433
Mailing Address - Fax:318-281-5431
Practice Address - Street 1:1917 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4069
Practice Address - Country:US
Practice Address - Phone:318-281-5433
Practice Address - Fax:318-281-5431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1996220Medicaid
LA1996220Medicaid