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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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