Provider Demographics
NPI:1588092373
Name:LIFENET, INC
Entity type:Organization
Organization Name:LIFENET, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, PATIENT BUSINESS SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-915-2301
Mailing Address - Street 1:621 CARNEGIE DR
Mailing Address - Street 2:STE 205
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2850 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61101-3543
Practice Address - Country:US
Practice Address - Phone:909-915-2315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARCH AIR MEDICAL SERVICE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1617853416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL583630Medicare UPIN