Provider Demographics
NPI:1124154133
Name:LIFE CARE MEDICAL, INC.
Entity type:Organization
Organization Name:LIFE CARE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSM, EMT-P
Authorized Official - Phone:9705-226-8022
Mailing Address - Street 1:104 PARK ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4135
Mailing Address - Country:US
Mailing Address - Phone:970-522-6802
Mailing Address - Fax:970-251-9960
Practice Address - Street 1:104 PARK ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4135
Practice Address - Country:US
Practice Address - Phone:970-522-6802
Practice Address - Fax:970-251-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06627533Medicaid
COC62753Medicare PIN