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Organization
LIFE LINE EMERGENCY MEDICAL RESPONSE SERVICE CORP
Active
Organization
LIFE LINE EMERGENCY MEDICAL RESPONSE SERVICE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN W MCCONNELL (PRESIDENT CEO)
(618) 997-4302
Entity
Organization
Contact information
Practice address
1003 WEST CHERRY STREET, MARION, IL 62959
(618) 997-4302
(618) 997-5389
Mailing address
1003 WEST CHERRY STREET, MARION, IL 62959
(618) 997-4302
(618) 997-5389
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
5222
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080893800
FEDERAL BLACK LUNG
—
01
—
10019731
BLUE CROSS BLUE SHIELD
IL
01
—
590009057
RAILROAD MEDICARE
—
01
—
610598100
FEDERAL WORKMAN COMP
—
Enumeration date
05/27/2006
Last updated
02/02/2012
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