Provider Demographics
NPI:1063715738
Name:LIFE SHIELD EMS
Entity type:Organization
Organization Name:LIFE SHIELD EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:THACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-814-4550
Mailing Address - Street 1:1158 FOREST PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3464
Mailing Address - Country:US
Mailing Address - Phone:678-814-4550
Mailing Address - Fax:770-783-6622
Practice Address - Street 1:1158 FOREST PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE CITY
Practice Address - State:GA
Practice Address - Zip Code:30260-3464
Practice Address - Country:US
Practice Address - Phone:678-814-4550
Practice Address - Fax:770-783-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031-26341600000X
GA031-25341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance