LIFELINC ANESTHESIA, PLLC

Provider Demographics

• NPI: 1801021464
• Name: LIFELINC ANESTHESIA, PLLC
• Entity Type: Organization
• Organization Name: LIFELINC ANESTHESIA, PLLC
• Authorized Official - Title/Position: COO
• Authorized Official - First Name: ERICA
• Authorized Official - Middle Name: N
• Authorized Official - Last Name: WARREN
• Authorized Official - Credentials: MHA
• Authorized Official - Phone: 901-207-2017
• Mailing Address - Street 1: 3340 PLAYERS CLUB PKWY
• Mailing Address - Street 2: SUITE 350
• Mailing Address - City: MEMPHIS
• Mailing Address - State: TN
• Mailing Address - Zip Code: 38125-8933
• Mailing Address - Country: US
• Mailing Address - Phone: 901-207-2017
• Mailing Address - Fax: 844-752-2163
• Practice Address - Street 1: 3340 PLAYERS CLUB PKWY STE 350
• Practice Address - City: MEMPHIS
• Practice Address - State: TN
• Practice Address - Zip Code: 38125-8949
• Practice Address - Country: US
• Practice Address - Phone: 901-207-2017
• Practice Address - Fax: 844-752-2163
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2009-05-26
• Last Update Date: 2020-09-29

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207L00000X	Allopathic & Osteopathic Physicians	Anesthesiology		Group - Multi-Specialty
No	367500000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Anesthetist, Certified Registered		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
PA	1029018500001	Medicaid
KY	7100313110	Medicaid
FL	002565700	Medicaid
MS	01886811	Medicaid
SC	GPB038	Medicaid
GA	003116254A	Medicaid
FL	005473200	Medicaid
FL	005473201	Medicaid
AR	179927002	Medicaid
TN	1514226	Medicaid
FL	005473202	Medicaid
FL	005473203	Medicaid
PA	329644	Medicare PIN
FL	005473200	Medicaid
FL	005473201	Medicaid
MS	01886811	Medicaid
FL	005473202	Medicaid
MS	279138	Medicare PIN
GA	003116254A	Medicaid
AR	179927002	Medicaid