Provider Demographics
NPI:1639750821
Name:LIFE TIME MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:LIFE TIME MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / TRANSPORTATION DRIVER
Authorized Official - Prefix:MR
Authorized Official - First Name:OBIORA
Authorized Official - Middle Name:JUNIOR
Authorized Official - Last Name:CHIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-267-5911
Mailing Address - Street 1:4644 SATURN RD APT 2003
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-6239
Mailing Address - Country:US
Mailing Address - Phone:469-267-5911
Mailing Address - Fax:
Practice Address - Street 1:4644 SATURN RD APT 2003
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-6239
Practice Address - Country:US
Practice Address - Phone:469-267-5911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)