# LIFE LINE EMERGENCY MEDICAL RESPONSE SERVICE CORP

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

## Provider details

- **NPI number:** 1962459834
- **Authorized official:** MR. KEVIN W MCCONNELL (PRESIDENT CEO)
- **Authorized official phone:** (618) 997-4302

## Contact information

- **Practice address:** 1003 WEST CHERRY STREET, MARION, IL 62959
- **Practice address phone:** (618) 997-4302
- **Practice address fax:** (618) 997-5389
- **Mailing address:** 1003 WEST CHERRY STREET, MARION, IL 62959
- **Mailing address phone:** (618) 997-4302
- **Mailing address fax:** (618) 997-5389

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 5222 | IL | Yes |

## Other

- **Enumeration date:** 05/27/2006
- **Last updated:** 02/02/2012

## 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 | — |