Provider Demographics
NPI:1972003655
Name:SILVER LIFT
Entity Type:Organization
Organization Name:SILVER LIFT
Other - Org Name:SILVER LIFT PROS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-663-9393
Mailing Address - Street 1:PO BOX 1602
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78646-1602
Mailing Address - Country:US
Mailing Address - Phone:512-663-9393
Mailing Address - Fax:
Practice Address - Street 1:2200 EMERALD ISLE DR
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-2362
Practice Address - Country:US
Practice Address - Phone:512-663-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)