Provider Demographics
NPI:1740681592
Name:LIFE MEDICAL CENTER INC
Entity type:Organization
Organization Name:LIFE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OSMARO
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-207-3399
Mailing Address - Street 1:1139 E JERSEY ST STE 408
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2446
Mailing Address - Country:US
Mailing Address - Phone:812-207-3399
Mailing Address - Fax:
Practice Address - Street 1:1139 E JERSEY ST STE 408
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2446
Practice Address - Country:US
Practice Address - Phone:812-207-3399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service