Provider Demographics
NPI:1487221628
Name:LIFELINC ANESTHESIA VI PC
Entity Type:Organization
Organization Name:LIFELINC ANESTHESIA VI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:901-844-1590
Mailing Address - Street 1:3340 PLAYERS CLUB PKWY STE 350
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8949
Mailing Address - Country:US
Mailing Address - Phone:901-207-2017
Mailing Address - Fax:844-752-2163
Practice Address - Street 1:75 NEILSON ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2468
Practice Address - Country:US
Practice Address - Phone:831-724-4741
Practice Address - Fax:844-752-2163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty