Provider Demographics
NPI:1578637765
Name:LIFELINE MEDICAL, INC.
Entity Type:Organization
Organization Name:LIFELINE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:LITTLE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-646-5030
Mailing Address - Street 1:PO BOX 1370
Mailing Address - Street 2:116 WEST LEE HIGHWAY
Mailing Address - City:CHILHOWIE
Mailing Address - State:VA
Mailing Address - Zip Code:24319-1370
Mailing Address - Country:US
Mailing Address - Phone:276-646-5030
Mailing Address - Fax:276-646-2223
Practice Address - Street 1:116 LEE HIGHWAY
Practice Address - Street 2:
Practice Address - City:CHILHOWIE
Practice Address - State:VA
Practice Address - Zip Code:24319
Practice Address - Country:US
Practice Address - Phone:276-646-5030
Practice Address - Fax:276-646-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206008393332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010303206Medicaid
VA010303206Medicaid