Organization
LIFELINC ANESTHESIA IV PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERICA WARREN (COO)
(901) 844-1590
Entity
Organization
Contact information
Practice address
3304 COOLEY CT, PORTAGE, MI 49024-7430
(269) 349-2266
(269) 349-0792
Mailing address
3340 PLAYERS CLUB PKWY, SUITE 350, MEMPHIS, TN 38125-8933
(901) 844-1590
(901) 844-1592
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
08/05/2015
Last updated
02/11/2020
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