Provider Demographics
NPI:1851445811
Name:LIFEGUARD TRANSPORTATION SERVICE
Entity Type:Organization
Organization Name:LIFEGUARD TRANSPORTATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-380-2065
Mailing Address - Street 1:PO BOX 1482
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32562-1482
Mailing Address - Country:US
Mailing Address - Phone:850-262-0154
Mailing Address - Fax:850-473-0159
Practice Address - Street 1:1165 ROBERT BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2013
Practice Address - Country:US
Practice Address - Phone:850-262-0154
Practice Address - Fax:850-473-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9110030341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1652431Medicaid
LA1652431Medicaid