Provider Demographics
NPI:1578009155
Name:FIRST-LINE LLC
Entity Type:Organization
Organization Name:FIRST-LINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:NRP
Authorized Official - Phone:601-572-9320
Mailing Address - Street 1:2354 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT GROVE
Mailing Address - State:MS
Mailing Address - Zip Code:39189-5189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2354 UNION RD
Practice Address - Street 2:
Practice Address - City:WALNUT GROVE
Practice Address - State:MS
Practice Address - Zip Code:39189-5189
Practice Address - Country:US
Practice Address - Phone:601-654-4171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
MS382LEAKE3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance