Provider Demographics
NPI:1689688517
Name:TEXAS LIFELINE CORPORATION OF LIVE OAK CO.
Entity Type:Organization
Organization Name:TEXAS LIFELINE CORPORATION OF LIVE OAK CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-327-8222
Mailing Address - Street 1:PO BOX 571909
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75357-1909
Mailing Address - Country:US
Mailing Address - Phone:214-327-8222
Mailing Address - Fax:214-388-2093
Practice Address - Street 1:5409 N JIM MILLER RD
Practice Address - Street 2:SUITE 203A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-1542
Practice Address - Country:US
Practice Address - Phone:214-327-8222
Practice Address - Fax:214-388-2093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300273341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB105Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER