Organization
LIFE AIR RESCUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAM ANDERSON (CHIEF FLIGHT NURSE)
(318) 681-4610
Entity
Organization
Contact information
Practice address
1 SAINT MARY PL, SHREVEPORT, LA 71101-4343
(318) 681-4610
Mailing address
PO BOX 37103, SHREVEPORT, LA 71133-7103
(318) 681-4610
Taxonomy
Speciality
Code
Description
License number
State
3416A0800X
Air Ambulance
Primary
9110026
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1675458
—
LA
01
—
B8086
BLUE CROSS/BLUE SHIELD
LA
Enumeration date
06/01/2006
Last updated
08/22/2020
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