# OSF LIFELINE AMBULANCE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OSF HEALTHCARE SYSTEM
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1619036829
- **Legal business name:** OSF HEALTHCARE SYSTEM
- **Authorized official:** JAMES M MOORE (CEO)
- **Authorized official phone:** (309) 655-2850

## Contact information

- **Practice address:** 318 ROXBURY RD, ROCKFORD, IL 61107-5090
- **Practice address phone:** (815) 395-4695
- **Practice address fax:** (805) 395-4643
- **Mailing address:** PO BOX 17115, ROCKFORD, IL 61110-7115

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | — | NULL | Yes |

## Other

- **Enumeration date:** 12/06/2006
- **Last updated:** 04/09/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 471203 | BLUE CROSS | IL |