Organization
LIFE GUARD INC
Active
Other names
Life Guard Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MATT SHIVELY (V.P.)
(304) 665-2346
Entity
Organization
Contact information
Practice address
71 E MAIN ST, MC CONNELSVILLE, OH 43756-1180
(740) 962-5223
(740) 962-5223
Mailing address
71 E MAIN ST, MC CONNELSVILLE, OH 43756-1180
(740) 962-5223
(740) 962-5223
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
HMEL 11133
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2412268
—
OH
Enumeration date
12/12/2006
Last updated
08/22/2020
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