Provider Demographics
NPI:1336477793
Name:LIFE NET MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:LIFE NET MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:GREEN
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-840-8240
Mailing Address - Street 1:1905 HARBORVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29510
Mailing Address - Country:US
Mailing Address - Phone:803-840-8240
Mailing Address - Fax:
Practice Address - Street 1:1905 HARBORVIEW DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29153-8306
Practice Address - Country:US
Practice Address - Phone:803-840-8240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEE DEE MEDICAL TRANSPORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport