Provider Demographics
NPI:1073734885
Name:LIFELINE AMBULANCE SERVICES L.L.C.
Entity type:Organization
Organization Name:LIFELINE AMBULANCE SERVICES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:956-722-7486
Mailing Address - Street 1:PO BOX 452145
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0053
Mailing Address - Country:US
Mailing Address - Phone:956-722-7486
Mailing Address - Fax:956-725-0271
Practice Address - Street 1:6502 N BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6444
Practice Address - Country:US
Practice Address - Phone:956-723-5421
Practice Address - Fax:956-725-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2400183416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158007801Medicaid
TXAMB701OtherBCBSTX
TXAMB566Medicare PIN