Provider Demographics
NPI:1710083308
Name:LIFELINE MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:LIFELINE MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EZE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NWOJI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:301-386-0000
Mailing Address - Street 1:1035 BLADENSBURG RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2922
Mailing Address - Country:US
Mailing Address - Phone:301-792-6649
Mailing Address - Fax:301-386-0002
Practice Address - Street 1:1035 BLADENSBURG RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2922
Practice Address - Country:US
Practice Address - Phone:301-386-0000
Practice Address - Fax:301-386-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD404305700332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0206009741OtherVIRGINIA MEDICAID
DC037185800Medicaid
MD404305700Medicaid
MD5341060001Medicare NSC