# LIFELINE AMBULANCE SERVICE, LLC

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

## Provider details

- **NPI number:** 1659321206
- **Authorized official:** MR. BRIAN JEROME CONNOR (PRESIDENT & CEO)
- **Authorized official phone:** (781) 953-6870

## Contact information

- **Practice address:** 11 STATE ST, WOBURN, MA 01801-2050
- **Practice address phone:** (781) 935-2220
- **Practice address fax:** (781) 935-0211
- **Mailing address:** 11 STATE ST, A, WOBURN, MA 01801-2050
- **Mailing address phone:** (781) 953-6870
- **Mailing address fax:** (781) 646-0020

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | 3100 | MA | Yes |

## Other

- **Enumeration date:** 05/12/2006
- **Last updated:** 06/23/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1700197 | — | MA |