Provider Demographics
NPI:1467455691
Name:LIFE EMERGENCY MEDICAL SERVICE, INC.
Entity Type:Organization
Organization Name:LIFE EMERGENCY MEDICAL SERVICE, INC.
Other - Org Name:LIFE EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-233-2245
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-0365
Mailing Address - Country:US
Mailing Address - Phone:580-233-2245
Mailing Address - Fax:580-242-0348
Practice Address - Street 1:302 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3808
Practice Address - Country:US
Practice Address - Phone:580-233-2245
Practice Address - Fax:580-242-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS0753416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00161773OtherRAILROAD MEDICARE #
OK730760393-001OtherBCBS PROVIDER #