# LIFE AIR RESCUE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659318517
- **Authorized official:** PAM ANDERSON (CHIEF FLIGHT NURSE)
- **Authorized official phone:** (318) 681-4610

## Contact information

- **Practice address:** 1 SAINT MARY PL, SHREVEPORT, LA 71101-4343
- **Practice address phone:** (318) 681-4610
- **Mailing address:** PO BOX 37103, SHREVEPORT, LA 71133-7103
- **Mailing address phone:** (318) 681-4610

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416A0800X | Air Ambulance | 9110026 | LA | Yes |

## Other

- **Enumeration date:** 06/01/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1675458 | — | LA |
| 01 | — | B8086 | BLUE CROSS/BLUE SHIELD | LA |