Organization
LIFE AMBULANCE SERVICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL DEATERLA (BILLING DEPARTMENT MANAGER)
(740) 353-7725
Entity
Organization
Contact information
Practice address
1641 OFFNERE ST, PORTSMOUTH, OH 45662-3537
(740) 353-7725
(740) 354-1859
Mailing address
1641 OFFNERE ST, PORTSMOUTH, OH 45662-3537
(740) 353-7725
(740) 354-1859
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
730012
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0595771
—
OH
05
—
55000160
—
KY
05
—
9000043000
—
WV
Enumeration date
05/18/2006
Last updated
10/30/2007
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