Provider Demographics
NPI:1528806171
Name:LIFE-LINE MEDICAL TRANSPORTATION INC.
Entity type:Organization
Organization Name:LIFE-LINE MEDICAL TRANSPORTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:352-630-2398
Mailing Address - Street 1:1867 WESTERN HILLS LN
Mailing Address - Street 2:
Mailing Address - City:MASCOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:34753-9639
Mailing Address - Country:US
Mailing Address - Phone:352-630-2398
Mailing Address - Fax:
Practice Address - Street 1:1326 W NORTH BLVD STE 9
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3997
Practice Address - Country:US
Practice Address - Phone:352-632-2398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker