Provider Demographics
NPI:1356333041
Name:LIFETIME AMBULANCE SERVICES INC
Entity Type:Organization
Organization Name:LIFETIME AMBULANCE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:ITRABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-606-5075
Mailing Address - Street 1:7111 HARWIN DR
Mailing Address - Street 2:250
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2129
Mailing Address - Country:US
Mailing Address - Phone:832-606-5075
Mailing Address - Fax:281-759-5027
Practice Address - Street 1:7111 HARWIN DR
Practice Address - Street 2:250
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2129
Practice Address - Country:US
Practice Address - Phone:832-606-5075
Practice Address - Fax:281-759-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101416341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168349201Medicaid
TX=========OtherEIN
TX=========OtherEIN