Organization
LIFELINE EMS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLIE ANDREW TACITO EMT (OWNER)
(901) 619-3127
Entity
Organization
Contact information
Practice address
510 E JACKSON AVE, WEST MEMPHIS, AR 72301-4336
(870) 735-9718
(870) 735-9718
Mailing address
510 E JACKSON AVE, WEST MEMPHIS, AR 72301-4336
(870) 735-9718
(870) 735-9718
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
0000010018
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186922715
—
AR
05
—
T000212
—
TN
Enumeration date
12/04/2007
Last updated
06/22/2011
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