Provider Demographics
NPI:1619238151
Name:LIFE LINE SCREENING OF AMERICA
Entity Type:Organization
Organization Name:LIFE LINE SCREENING OF AMERICA
Other - Org Name:LIFE LINE SCREENING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-581-6556
Mailing Address - Street 1:6150 OAK TREE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2569
Mailing Address - Country:US
Mailing Address - Phone:216-581-6556
Mailing Address - Fax:216-581-9611
Practice Address - Street 1:6150 OAK TREE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2569
Practice Address - Country:US
Practice Address - Phone:216-581-6556
Practice Address - Fax:216-581-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D1048587291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory