Provider Demographics
NPI:1609129048
Name:LIFE LINE MEDICAL TRANSPORT.,LLC
Entity Type:Organization
Organization Name:LIFE LINE MEDICAL TRANSPORT.,LLC
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOWLID
Authorized Official - Middle Name:DALMAR
Authorized Official - Last Name:AWIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-598-4177
Mailing Address - Street 1:2928 WESTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-4516
Mailing Address - Country:US
Mailing Address - Phone:614-598-4177
Mailing Address - Fax:614-414-6066
Practice Address - Street 1:2928 WESTERVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-4516
Practice Address - Country:US
Practice Address - Phone:614-598-4177
Practice Address - Fax:614-414-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH259395343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)