Provider Demographics
NPI:1497597173
Name:LIFE LINK AMBULANCE SERVICE
Entity type:Organization
Organization Name:LIFE LINK AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:STAPLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:843-902-7582
Mailing Address - Street 1:6820 LESLIE LEWIS RD
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-5897
Mailing Address - Country:US
Mailing Address - Phone:843-902-7582
Mailing Address - Fax:
Practice Address - Street 1:6820 LESLIE LEWIS RD
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-5897
Practice Address - Country:US
Practice Address - Phone:843-902-7582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport