Provider Demographics
NPI:1568288009
Name:LIFEFORCE MEDICAL PA
Entity type:Organization
Organization Name:LIFEFORCE MEDICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. PROVIDER RELATIONS REP.
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-417-6265
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94023-0085
Mailing Address - Country:US
Mailing Address - Phone:855-656-1266
Mailing Address - Fax:
Practice Address - Street 1:211 E 43RD ST STE 7-100
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4707
Practice Address - Country:US
Practice Address - Phone:855-656-1266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty